艾曲泊帕治疗成人原发免疫性血小板减少症的近期疗效及不良反应的荟萃分析

目的 综合评价艾曲泊帕治疗成人原发免疫性血小板减少症（ITP）的近期疗效、出血好转情况与安全性。方法 检索2018年4月前pubmed,万方数据库,维普数据库,CNKI,中国生物医学文献数据库,纳入艾曲泊帕治疗成人ITP的随机对照研究或单臂研究。评价纳入研究的方法学质量并提取数据后,采用R软件的meta程序包对结果进行合并分析。结果 共纳入5个随机对照试验和2个单臂临床研究,包括633例成人ITP患者。艾曲泊帕治疗组总有效率68%,出血好转率65%,与安慰剂组比较,总有效率、出血好转率有明显差异,不良反应差异无统计学意义。结论 艾曲泊帕治疗成人ITP疗效确切,不良反应低,可作为成人ITP治疗的新选择。     

2014-2016年云南省宣威市死因监测数据库清洗探讨

目的 对肺癌高发的云南省宣威市2014－2016年死因登记数据进行数据清洗,分析数据上报及系统填报过程中存在的问题,以提升死因监测工作质量及基层人员的数据分析能力。方法 采用“人口死亡信息登记管理系统”（新系统）进行死因监测网络直报,对数据进行了查重,极值、异常值和缺失值处理及逻辑核查等;对异常数据进行频数统计并分析原因;计算各年度各类疾病的构成比,判断清洗后的数据质量。结果 数据库有效记录24 704条,删除率为1.10%;身份证与出生日期计算的年龄与上报年龄不一致率≤0.58%;68.82%记录上报时间距死亡时间>1个月,约9%记录为死亡次年或第3年上报。在死亡次年或第3年上报的病例中,有454例为肺癌,且78.63%来自于肺癌高发区;131例重复上报病例主要集中在死亡次年1－3月,且第2次上报的诊断级别及依据均较第1次弱;不明死亡原因的比例为2%左右。结论 采用新系统进行死因监测网络直报后,监测数据质量有较大提高。但死因监测工作仍需加强数据上报的及时性;对于次年补充上报病例,需要有严格审核机制;应对新系统的部分功能进行升级,以技术手段促进监测工作质量。     

KID, a Kinase Inhibitor Database project.

The Kinase Inhibitor Database is a small specialized database dedicated to the gathering of information on protein kinase inhibitors. The database is accessible through the World Wide Web system and gives access to structural and bibliographic information on protein kinase inhibitors. The data in the database will be collected and submitted by researchers working in the kinase inhibitor field. The submitted data will be checked by the curator of the database before entry.     

一起海陆边境城市新型冠状病毒肺炎疫情暴发溯源调查

目的 分析2021年12月广西海陆边境城市（D市）一起新型冠状病毒肺炎（新冠肺炎）疫情暴发的流行特征及溯源过程,为今后类似疫情应急处置及科学溯源提供科学依据。方法 按照《新型冠状病毒感染的肺炎病例流行病学调查方案（第八版）》对病例开展流行病学调查,用实时荧光定量(RT-PCR)法对标本进行新冠病毒核酸检测,阳性标本进行新冠病毒全基因组二代测序和系统发育分析。采用R4.1.3统计软件进行数据统计分析。结果 本次疫情累计感染病例20例,波及6个家庭,平均潜伏期（4.6±2.2） d。获得19例病例新冠病毒基因组有效序列,与武汉参考株（NC＿045512）序列相比,本起疫情病例新冠病毒基因组序列存在35～36个核苷酸突变位点,属于德尔塔（VOC/Delta）变异株（AY.57进化分支）,新冠病毒刺突（S）蛋白均存在相同的11个氨基酸突变位点,与全球新冠病毒基因组数据库（GISAID）中邻国上传的2条新冠病毒基因组序列高度同源。结论 本起疫情是一起由渔民外出作业接触邻国境外人员感染导致本地社区传播,今后应加强边境村民管理和边境流行株监测,尽早发现并处置疫情。     

Prevalence of diabetes in france and drug use: study based on the French pharmacovigilance database

AIM: The aim of this study was to investigate the use of the French Pharmacovigilance Database to estimate characteristics of drug utilization in specific diseases. MATERIALS AND METHOD: We identified diabetic patients from the French Pharmacovigilance Database between 2002 and 2005. In this population, we studied demographic characteristics, and the patterns of drug use, particularly hypoglycemiant drug use and other drug exposure. In order to validate this approach, we compared our data to a population of patients with diabetes identified from the French Health Insurance System claims database in one French area. RESULTS: The estimation of prevalence of diabetes was very close in the sources: 2.7% in the French Pharmacovigilance Database and 3.2% in the French Health Insurance System claims database. We found similar results as well for demographic characteristics as for hypoglycemiant drug use and other drug exposure. CONCLUSION: These results suggest that the French Pharmacovigilance Database may be used to investigate drug utilization patterns.     

Development of an integrated stroke outcomes database within Veterans Health Administration

A fundamental goal of the Rehabilitation Outcomes Research Center of Excellence is to improve care and outcomes for veterans with rehabilitation needs. To achieve this goal, the Center's primary objective is increasing research capacity. The Integrated Stroke Outcomes Database is a collection of Veterans Health Administration (VHA) clinical and administrative data containing patient information on a cohort of stroke patients found in the Functional Status Outcomes Database (FSOD), National Patient Care Database (NPCD), and other VHA sources. Clinical and administrative data were abstracted from several VHA data sources and linked to form an integrated outcomes database. A primary cohort of stroke patients treated during fiscal year (FY) 2001 was identified from the FSOD. Matching data from the NPCD, Decision Support System, Health Economics Resource Center, and the National Veterans Survey were obtained, merged, and reported in brief. This integrated database structure will provide valuable support to enhance the VHA capacity to perform stroke rehabilitation research.     

Bystander activity of Ad-mda7: human MDA-7 protein kills melanoma cells via an IL-20 receptor-dependent but STAT3-independent mechanism.

The melanoma differentiation-associated gene-7 (mda-7/IL24) is a unique member of the IL-10 family of cytokines, with ubiquitous tumor cell proapoptotic activity. Transduction of tumor or normal cells with the mda-7 gene results in secretion of glycosylated MDA-7 protein. Recent data indicate that secreted MDA-7 protein functions as a pro-Th1 cytokine and as a potent antiangiogenic molecule. MDA-7 protein binds two distinct type II cytokine heterodimeric receptor complexes, IL-20R1/IL-20R2 (type 1 IL-20R) and IL-22R1/IL-20R2 (type 2 IL-20R). In this study we analyzed the activity of glycosylated secreted MDA-7 against human melanoma cells. MDA-7 protein induces phosphorylation and nuclear translocation of STAT3 in melanoma cells via both type 1 and type 2 IL-20R. MDA-7 induces dose-dependent cell death in melanoma tumor cells. MDA-7 receptor engagement results in up-regulation of BAX and subsequent apoptosis induction; this effect is mediated by STAT3-independent signaling. Additional IL-10 family members (IL-10, -19, -20, and -22) also activate STAT3; however, these ligands do not activate death pathways in melanoma. In normal cells, MDA-7 can bind to its cognate receptors and induce phosphorylation of STAT3, without cytotoxic sequelae. This study defines a tumor-selective cytotoxic bystander role for secreted MDA-7 protein and identifies a novel receptor-mediated, STAT3-independent, and PKR-independent death pathway.     

Predicting pharmacy costs and other medical costs using diagnoses and drug claims

BACKGROUND: Predicting health care costs for individuals and populations is essential for managing care. However, the comparative power of diagnostic and drug data for predicting future costs has not been closely examined. OBJECTIVE: We sought to compare the predictive performance of claims-based models using diagnoses, drugs claims, and combined data to predict health care costs. SUBJECTS: More than 1 million commercially insured, nonelderly individuals in a national (MEDSTAT MarketScan) research database comprised our sample. MEASURES: We used 1997 and 1998 drug and diagnostic profiles to predict costs in 1998 and 1999, respectively. To assess model performance, we compared R2 values and predictive ratios (predicted costs/actual costs) for important subgroups. RESULTS: Models using both drug and diagnostic data best predicted subsequent-year total health care costs (highest R2 = 0.168 versus 0.116 and 0.146 for models based on drug or diagnostic data alone, respectively), with highly accurate predictive ratios (0.95-1.05) for subgroups of patients with major medical conditions. Models predicting pharmacy costs had substantially higher R2 values than models predicting other medical costs (highest R2 0.493 versus 0.124). Drug-based models predicted future pharmacy costs better than diagnosis-based models (highest R2 = 0.482 versus 0.243), whereas diagnosis-based models predicted total costs (highest R2 = 0.146 versus 0.116) and nonpharmacy costs (highest R2 = 0.116 versus 0.071) more effectively than drug-based models. Newer models had markedly higher R values than older ones, largely because of richer data rather than model refinements. CONCLUSIONS: Combined drug and diagnostic data predicts total health care costs better than either type of data alone. Pharmacy spending is particularly predictable from drug data, whereas diagnoses are more useful than drugs for predicting other medical costs and total costs. Using even slightly more recent data can substantially boost model performance measures; thus, model comparisons should be conducted on the same dataset.     

Identification of novel missense mutations of cardiac ryanodine receptor gene in exercise-induced sudden death at autopsy

Mutations in the cardiac ryanodine type 2 receptor (RyR2) gene are associated with catecholaminergic polymorphic ventricular tachycardia. We hypothesized that these mutations could be detected at autopsy in cases of exercise-triggered sudden death. Fourteen sudden death patients, eight males and six females, were studied at autopsy based on apparent sudden cardiac death, without significant anatomical abnormalities. The coding regions of arrhythmia genes were amplified by polymerase chain reaction and directly sequenced. Three novel RyR2 mutations, R414C, F2331S, and R2401L, were identified in three unrelated patients (two males and one female; mean age at death, 12 +/- 2 years), all performing strenuous activity at the time of death or collapse. These mutations were located in highly conserved regions where arrhythmia-linked RyR2 mutations clustered. Although G269S in the KVLQT1 gene was detected in a female with known family history of syncope and sudden cardiac death, no other mutations were found in any of the 14 cases, and no other mutations was found in 200 controls. The absence of structural cardiac disease in physical activity-induced sudden death and the finding of three novel RyR2 mutations suggest that mutation screening in such cases should include RyR2.     

History, implementation, and current status of the National Spinal Cord Injury Database

OBJECTIVE: To summarize a 25-year history of the Model Spinal Cord Injury Program and the coexistent National Spinal Cord Injury Database and provide the status of the Database with a discussion of the strengths and weaknesses. DESIGN: Inception cohort. SETTING: Model spinal cord injury systems throughout the United States. RESULTS: As of September 1998, the National Spinal Cord Injury Database included abbreviated registry records on 6,085 new patients, more complete initial injury and hospitalization records on 18,969 new patients, and 78,627 annual follow up records on those persons. Although stability and continuity of the Database has been a priority since it was started, some changes were needed to meet the changes in health care, health care policy, and new technology. CONCLUSION: This large database can now provide a wealth of information about short- and long-term outcomes, provide data on which future health care policies can be evaluated, and act as a source for answers to future research questions.     

中国循证医学/Cochrane中心临床治疗和诊断试验数据库的建立

目的建立中国循证医学/Cochrane中心临床治疗和诊断试验数据库,为临床医疗、教学、科研和系统评价者提供科学可靠的数据,同时向国际Cochrane协作网提供中国的临床医学研究资料.方法采用手检与机检相结合的方法,按国际Cochrane协作网和临床流行病学的标准收集数据.结果截至2003年12月,中国循证医学/Cochrane中心数据库已收集各专业的RCT和CCT 16 652条诊断实验(DT)3 786条,已向国际Cochrane协作网提交RCT和CCT 4 966条,已建立19个专业数据库.结论由中国Cochrane中心组织、全国各专业医护和技术人员承担的临床治疗与诊断试验数据库建库工作现已初具规模,并开始向国内外提供信息服务.     

Cultural Cues: Review of Qualitative Evidence of Patient‐Centered Care in Patients with Nonmalignant Chronic Pain

The purpose of this paper was to examine published qualitative studies that explored the beliefs, values, and behaviors of patients with nonmalignant chronic pain during their interactions with the healthcare system. The findings were used as “cultural cues” to create patient‐centered care. A literature review of primary qualitative studies that focused on beliefs, values, or behaviors of patients with chronic nonmalignant pain in the formal healthcare setting was conducted. CINAHL, Medline, Pubmed, PsychInfo, Sociology Abstracts, Cochrane Library Database, Proquest Dissertation and Thesis, and EmBase served as the database for the research. The findings from the studies fell into two categories: beliefs and expectations about appropriate treatment and the behaviors patients may exhibit if they perceive they are not receiving appropriate treatment. Qualitative findings showed that the beliefs, values, and behaviors of patients with nonmalignant chronic pain exhibited during their interactions with the healthcare system created a set of “cultural cues” for providers.     

基于数据挖掘技术分析新型冠状病毒肺炎恢复期艾灸治疗的选穴特点

目的：基于数据挖掘技术统计分析新冠肺炎恢复期艾灸组方规律及选穴特点。方法：检索中国生物医学文献数据库、中国期刊全文数据库、维普期刊全文数据库和PubMed数据库,系统收集了2020年7月31日前发表的关于新型冠状病毒肺炎恢复期艾灸诊疗方案,并建立了艾灸处方数据库,采用数据分析软件SPSS24.0、SPSS Modeler、Excel对数据进行分析处理,总结证型频次、穴位频次、穴位归经、艾灸方式、特定穴频次、经穴分布规律,分析关联规则。结果：本研究共纳入新型冠状病毒肺炎恢复期艾灸处方30首,共涉及证型3种,分别是肺脾气虚证、肺胃阴虚证、气阴两虚证;共涉及穴位31个,高频穴位6个;穴位主要归于膀胱经、任脉、督脉、胃经、脾经、大肠经、肺经;温和类艾灸方式出现的频次较高,占艾灸方式比为94.74%,而强刺激类艾灸方式出现的频次较少,占5.26%;特定穴占经穴比为74.19%,其中交会穴频次为60次,背俞穴频次为25次,五腧穴频次为24次,募穴频次为31次;四肢部穴数为11个（35.48%）,躯干部穴数为17个（54.84%）。通过关联分析、聚类分析、复杂网络分析得出核心穴位组合为神阙、中脘、肺俞、关元、大椎、足三里。结论：新型冠状病毒肺炎恢复期艾灸治疗的核心穴位组合为神阙、中脘、肺俞、关元、大椎、足三里。对恢复期艾灸穴位进行共性探讨,在共性穴位基础上辨证论治,可使患者更快恢复,更早回归社会。     

Effect of deprivation and gender on the incidence and management of acute brain disorders

OBJECTIVE: To determine the impact of deprivation and gender on the incidence and emergency management of acute brain disorders. DESIGN: Retrospective database review of mortality, hospital discharge, and ICU discharge data. SETTING: Lothian Health Board area, 1995-1999. PATIENTS AND PARTICIPANTS: All persons over the age of 15 dying or being discharged from hospital with a primary diagnosis of stroke, epilepsy, subarachnoid haemorrhage (SAH) or traumatic brain injury; patients registered in the Scottish Intensive Care Society Audit Database as having been discharged from the supraregional neurosciences intensive care unit with one of these as a primary diagnoses and a home postcode within the Lothian Health Board area. MEASUREMENTS AND RESULTS: Standardised ratios were calculated for hospital admission, mortality, and ICU admission by deprivation category and gender. Data were available for 29,205 hospital admissions, 5,227 deaths, and 360 ICU admissions. For all diagnoses, deprivation was associated with higher rates of hospital admission and death. Deprivation was associated with lower rates of ICU admission for traumatic brain injury and stroke. There was a U-shaped relationship between deprivation and ICU admission with epilepsy. There were no gender differences in rates of ICU admission. Males had higher rates of hospital admission for all conditions and of death from epilepsy and SAH, and lower rates of death from stroke. CONCLUSIONS: We have demonstrated deprivation- and gender- differences in the incidence and emergency management of four acute brain disorders. The identification of the source(s) of these differences is an important subject for further research.     

Maintenance of a nutrient database for clinical trials

Maintenance of a nutrient database for use in dietary analysis for clinical trials and other medical research studies is described. The database, maintained at the University of Minnesota's Nutrition Coordinating Center (NCC), has been used to calculate dietary intake data for a wide range of diet-disease related investigations including studies on cardiovascular disease, hypertension, cancer, gastroenterology, and osteoporosis. Potential sources of error associated with nutrient databases are identified. Criteria are provided for the selection of a nutrient database to meet study objectives and to minimize the potential for errors and inconsistencies. NCC database maintenance procedures, designed to provide updated and verified nutrient calculations for clinical research, involve adherence to standardized procedures for all aspects of database maintenance including data selection, imputations, quality control, recipe calculations, and documentation. By maintaining multiple versions of the database, the NCC is able to update and expand a working version of the database while providing database stability for individual research studies.     

Predicting in-hospital mortality. A comparison of severity measurement approaches.

Hospital mortality statistics derived from administrative data may not adjust adequately for patient risk on admission. Using clinical data collected from the medical record, this study compared the ability of six models to predict in-hospital death, including one model based on administrative data (age, sex, and principal and secondary diagnoses), one on admission MedisGroups score, and one on an approximation of the Acute Physiology Score (APS) from the revised Acute Physiology and Chronic Health Evaluation (APACHE II), as well as three empirically derived models. The database from 24 hospitals included 16,855 cases involving five medical conditions, with an overall in-hospital mortality rate of 15.6%. The administrative data model fit least well (R-squared values ranged from 1.9-5.5% across the five conditions). Admission MedisGroups score and the proxy APS score did better, with R-squared values ranging from 4.9% to 25.9%. Two empirical models based on small subsets of explanatory variables performed best (R-squared values ranged from 18.5-29.9%). The preceding models had the same relative performances after cross-validation using split samples. However, the high R-squared values produced by the full empirical models (using 40 or more explanatory variables) were not preserved when they were cross-validated. Most of the predictive clinical findings were general physiologic measures that were similar across conditions; only a fifth of predictors were condition-specific. Therefore, an efficient approach to risk-adjusting in-hospital mortality figures may involve adding a small subset of condition-specific clinical variables to a core group of acute physiologic variables. The best predictive models employ condition-specific weighting of even the generic clinical findings.     

Creating and Analyzing a Statewide Nursing Quality Measurement Database

PURPOSE: To explicate a replicable methodology for designing and analyzing a large ongoing reliable and valid quality database to examine nurse staffing and patient care outcomes in acute care hospitals. DESIGN: Prospective nurse staffing, process of care, and patient outcomes data based on the American Nurses Association's (ANA) nursing quality indicators collected from a voluntary convenience sample at acute care hospitals in California with rolling-site accrual. METHODS: The ongoing CalNOC database development and repository project, the largest statewide effort of its kind in the United States (US), currently includes data on hospital nurse staffing, patient days, patient falls, pressure ulcer and restraint prevalence, registered nurse (RN) education, and patients' perceptions of satisfaction with care. FINDINGS: As of May 2003, the CalNOC database contained staffing data from 842 units in 134 acute care hospitals over 20 quarters from April 1998 to March 2003. The repository also included clinical outcome information on 34,262 reported patient falls, pressure ulcer prevalence data on 41,982 patient observations, and service outcome data on patient satisfaction from 26,461 patients. Participating hospitals receive quarterly reports allowing them to benchmark their own performance against other participating hospitals. CalNOC methods have been adapted and replicated by both the Military Nursing Outcomes Database and VA Nursing Outcomes Database projects, and CalNOC nursing-sensitive measures have been endorsed by the National Quality Forum. CONCLUSIONS: This working model for collecting reliable and valid data was derived from multiple hospitals across California. The data are the basis for studies to contribute to the development of evidence-based public policy, and for ongoing study of the effects of nurse staffing on clinical and service outcomes.     

The Design and Implementation of a Computerised Inpatient Database for the Efficient Delivery of Palliative Care: with a Brief Review of the Literature

A database is electronic information. Substantial improvement in the quality of life of cancer patients and their families could be effected by the implementation of existing knowledge of pain and symptom control. The development of a standardised assessment system in the form of a computer database would highlight areas warranting focused attention. Moreover, such a system would provide a frame of reference against which ongoing clinical, pharmacological and epidemiological research could then be applied. We present the design of an inpatient database being piloted at the Centre for Palliative Care (CPCI).

Our focus is the development of a standardised instrument for in patients admitted to our hospice and tertiary palliative care unit, and then an ongoing observational system which is maintained on a database throughout the phase of care.

The development of the database was effected on user-friendly computer software. The free fields for data entry were constructed for the repository of inpatient information on admission-related data, such as socio-demography, medical diagnosis, clinical indicators, and medications. Subsequently, this was supplemented with inpatient progress data concerning consultations, progress of clinical indicators, and interventions required, as well as changes in medication use, and eventual separation information upon discharge or death. Although a number of different patient criteria could be used to link a patient's data, the unique hospital or hospice patient number was used as the principal data link between layouts of data for storage and retrieval of information.     

数据库管理对提高儿童哮喘治疗质量的临床研究

目的 研究数据库管理系统对于提高儿童哮喘治疗质量的意义.方法 在中山市博爱医院儿童哮喘中心建立中山市不同年龄段哮喘儿童的临床资料数据库,通过数据库的信息对中山市哮喘儿童进行定期电话追踪、督导用药以及随访宣教工作.项目运行两年,运行后与既往用纸质专科病案管理的哮喘病人进行对比,比较两者的社会效益和治疗质量.结果 数据库规范化管理资料检索时间较传统纸质病案检索时间明显减少,数据库规范化管理的哮喘患儿比既往用纸质专科病案管理的哮喘病人的复诊率以及临床控制率提高、再次人院率降低以及家属对管理的满意度上升,P值均＜0.05,有显著性差异.结论 数据库管理系统可以明显提高哮喘患儿的复诊率以及临床控制率、降低哮喘的复发率,值得进一步推广.

Abstract：

Objective To investigate effectiveness of database management to improve the quality of care in the childhood asthma. Methods A database was established on extensive data which were collected from different regions and different age children with asthma of the Childhood Asthma Center of Boai Hospital in Zhongshan City. The patients were called and visited regularly according to the database, then, supervised their rational medication and performed health education. The program had been running for two years. The social benefit and treatment quality were compared with specialized paper medical record management. Results Database standardized management saved considerable time retrieval of information. Clinical controlling ratio, subsequent visit regularly and parent's satifactions were improved noticeably. Children were less to be readmitted to the hospital Conclusions The database management can increase rates of return visit and clinical controlling, and lower recrudescent rate of asthma Consequently, it is worth being further popularized.