Developing rational protocols for paediatric psychopharmacological prescribing.

The number of child psychiatrists, paediatricians and general practitioners prescribing psychotropic medication for children in the UK is increasing. Medication is being used not just to treat children of normal intelligence with hyperkinetic disorder or depression, but also to modify behavioural problems in children with developmental disorders and severe learning difficulties. Literature reviews highlight the lack of robust randomized controlled drug trials on which to base clinical practice and the authors have found no appropriate existing protocols to help develop a systematized approach. Against such a background the authors have developed a comprehensive set of protocols covering prescribing details for individual drugs, and also addressing issues such as informed consent, long-term monitoring and school liaison. All children referred to the authors' clinics go through a standardized decision-making process. This article describes both the protocols themselves and the philosophies that guided their development. The authors describe how such a system benefits the children, their families, general practitioners and schools, whilst also facilitating audit and research.     

医保与医院信息管理系统接口软件的探讨

厦门医疗保险信息管理系统是以城域网为主干的大型计算机管理系统,已正常运转了两年。作为医疗保险定点医疗机构上网的有５１ 所,其中,全部三级医院和大部分二级医院已开发应用信息系统。因此,医保系统与医院系统的接口问题必须得到解决。接口软件必须达到３ 个要求：医疗消费数据的唯一性、医保系统的安全性、高效快速的性能。医保系统与医院系统的接口采用３ 种方案：无缝、数据扫描、数据包交换。通过这３ 种方案,较好地解决了接口问题     

统计软件平台结构研究

讨论了统计软件平台的概念,抽象描述了统计软件平台模型和统计软件平台体系结构,着重介绍了数据字典,统计分析和历史数据处理.采用层次支持的开放式软件结构,并综合统计事务中的各种统计需求设计统计软件平台,使实现的系统具有良好的动态可扩充性.中间件技术的应用使该平台能满足各种数据应用的特定需要.应用数据字典作为控制参数也使得该平台能够满足不同用户的统计要求.     

Diffusion of information about genetic risk within families

Recent developments in genetics are likely to exacerbate the ethical issues in clinical practice, especially with regard to privacy and disclosure of genetic information. To evaluate the behaviour of patients with respect to transmitting carrier information, we undertook a survey of 283 families with a balanced chromosomal rearrangement as a model. In these families, 1816 relatives were considered at risk and 806 of them were karyotyped (44.4%). The percentage of karyotypes performed is significantly related to the number of living children of the index couple, the reason for referral, the nature of the anomaly, the training of the counsellor and the age of the index case. This study shows the limits of the screening of at risk individuals within families, based on the willingness of the patients, and addresses practical and ethical issues around family disclosure in medical genetics.     

Application of Akaike's information criterion (AIC) in the evaluation of linear pharmacokinetic equations

According to linear pharmacokinetics, the time course of plasma concentration of a drug, C_p,is expressed by a sum of exponential functions, C_p= _i=1 ⁿ a_i .This article describes a statistical technique to estimate the number of exponential terms, n,for the time course of drug by the application of Akaike's information criterion (AIC). Plasma concentrations of ethoxybenzamide, sulfisoxazole, bishydroxycoumarin, and diazepam measured following bolus intravenous injection were used as clinical examples for this method. Selection of models is compared between the AIC method and an Ftest method at significance levels of 5% and 1%.     

Do bilineal pedigrees represent a problem for linkage analysis? basic principles and simulation results for single-gene diseases with no heterogeneity

Some investigators have expressed concern--especially for psychiatric disorders--that bilineal pedigrees should not be included in linkage studies. This study compares the "informativeness" of bilineal and unilineal families for a homogeneous single-gene disorder. Three approaches were used: (1) simulation studies of three-generation pedigrees, (2) calculation of expected lod scores (ELODs) in nuclear families, and (3) calculation of Fisher's information number I(theta) in nuclear families. The simulation studies in (1) permitted a realistic comparison between bilineal datasets and purely unilineal ones. The calculations in nuclear families in (2) and (3) then made it possible to analyze the sources of information loss in bilineal families. Overall, in datasets of five three-generation pedigrees each, the drop in mean maximum lod score was approximately 50% from purely unilineal datasets to extremely bilineal ones. In less-extreme bilineal datasets, which are closer to most real data than the extremely bilineal ones, the drops in lod score were very small--less than 10% in some, and practically zero in others. The details will vary, depending on size and structure of the pedigree, genetic model, true value of the recombination fraction, and informativeness of the marker. However, these results imply that the information loss due to bilineality is not necessarily very great. The nuclear-family calculations showed that for phase-known matings there is relatively little information loss in bilineal families, but for phase-unknown matings there the loss is much greater. In conclusion, for single-gene disorders with no genetic heterogeneity, whereas bilineal families can be less informative than comparable unilineal families, they are not so much less informative that they should automatically be discarded from linkage datasets. The implications of bilineal pedigrees for linkage studies of heterogeneous disorders are also discussed.     

Digital psychiatry

The American managed care movement has been viewed as a big experiment and is being watched closely by the rest of the world. In the meanwhile, computer-based information technology (IT) is changing the practice of medicine, much more rapidly than managed care. A New World of digitized knowledge and information has been created. Although literature on IT in psychiatry is largely absent in peer-reviewed psychiatric journals, IT is finding its way into all aspects of medicine, particularly psychiatry. Telepsychiatry programs are becoming very popular. At the same time, medical information sites are flourishing and evolving into a new health-care industry. Patient-physician information asymmetry is decreasing as patients are gaining easy access to medical information hitherto only available to professionals. Thus, psychiatry is facing another paradigm shift, at a time when most attention has been focused on managed care. In this new digital world, knowledge and information are no longer the sole property of professionals. Value will migrate from traditional in-person office-based therapy to digital clinical products, from in-person library search and classroom didactic instruction to interactive on-line searches and distance learning. In this time of value migration, psychiatrists have to determine what their 'distinctive competence' is and where best to add value in the health-care delivery value chain. The authors assess the impact of IT on clinical psychiatry and review how clinical practice, education and research in psychiatry are expected to change in this emerging digital world.     

论虚寒证基因芯片及生物信息的高起点切入研究——分子中医研究系列报道(1)

从辨证论治的 3点不足 ,前瞻现代数理思维的重要性 ,引进前沿生物科技的必要性 ;从虚寒证的研究基础和寒的本义论述了虚寒证现代研究的优势 ;对于虚寒证等中医复杂证候的研究 ,必须多学科的交叉 ,尤其是目前可利用的利器 :基因芯片、生物信息等 ,可望从虚寒证的基因组研究切入 ,突破“证”的瓶颈     

武汉市25家医院2002年第4季度抗感染药物应用分析

目的 :了解抗感染药在武汉市 2 5家医院的应用情况 ,作出客观评估 ,以供药品生产、经营、应用等部门参考。方法 :调查武汉市 2 5家医院 2 0 0 2年第 4季度抗感染药的购进金额 ,进行分类排序、前 34位药品的排序及构成比例排序。结果 :抗感染药物购用金额占总金额的 39 5 2 % ,β -内酰胺类药物占抗感染药物总金额的 5 9 19% ,前 34位抗感染药物购用金额占抗感染药总金额的 79 5 3%。结论 :抗感染类药品购进金额比例远高于其它类药品 ,与发达地区和国家相比有一定差距 ,应注意合理应用 ,防止滥用     

中国汉族人群遗传性聋基因座位STR位点的遗传多态性研究

目的 研究中国汉族人群10个遗传性聋基因座位的短串连重复序列(STR)的遗传多态性。方法 应用PCR方法对10个位点进行扩增，变性聚丙烯酰胺凝胶电泳分离，记录基因型。采用PPAP软件计算正常人各STR位点等位片段频率、基因型频率、预期基因型频率、多态信息量(PIC)和Hardy-Weinberg平衡吻合性检验。结果 中国汉族人群D6S287、D8S1132、D13S1275、D15S130、D1S2726、D4S3038、D2S2380、D22S282、D14S1042、D7S529各位点分别检出10个、9个、8个、7个、7个、7个、6个、6个、6个及5个等位片段，多态性分布均符合Hardy-Weinberg平衡定律。各位点PIC值分别为0．879、0．854、0．864、0．821、0．686、0．794、0．764、0．732、0．773、0．712；杂合度均高于0．7。结论 中国汉族人群10个位点STR均具有较高的杂合度和多态信息量，是较理想的遗传标记。