大数据时代的药品安全主动监测:对照选择的挑战与机遇

电子医疗数据已成为大数据时代开展药品安全主动监测的重要资源。基于此确认药品与不良事件是否存在关联，要回归传统的流行病学研究设计，选取恰当的对照进行对比。本文主要阐述不同对照选取的原理、适用情形，介绍、评价并比较各种对照选取的思路与参数，引入对照选择批量化实现的进展性成果，以期为我国利用电子医疗数据开展上市后药品安全性监测提供方法学参考。     

8种寄生虫病例分析

本文报道并分析8例寄生虫病例,其中包括脑裂头蚴病、眼部裂头蚴病、肺吸虫幼虫移行症、肺吸虫病、钩虫病、肝吸虫病、包虫病和广州管圆线虫病各1例。8例寄生虫病均有不同程度的误诊,其中6例在寄生虫抗体筛查检测阳性后得以确诊。因此,寄生虫病应引起临床医生的重视,抗体筛查有助于发现寄生虫病例。     

天然放射性气溶胶的粒径分布及其测量方法

天然放射性气溶胶粒径分布的变化会引起氡及其子体所致肺剂量的较大涨落。由于我国对其报道甚少，在肺剂量估算中均引用ＵＮＳＣＥＡＲ的推荐值。为验证这种引用的合理性和建立气溶胶粒径分布的测量方法，开展本项研究。方法采用金属丝网筛（１６５目）扩散法测量天然空气经不同数目网筛扩散前后的放射性浓度比（衰减比）来绘制衰减曲线，然后用池边模式计算出粒径分布曲线。衰减比、粒径分布的计算和曲线的绘制均采用计算机。结果室内外天然放射性气溶胶粒径呈几何正态分布，分布的峰值的平均值分别为（０．２０±０．０９）μｍ和（０．２７±０．１１）μｍ。粒径分布和氡浓度、气压、气温、湿度等未发现相关关系。结论本研究结果与ＵＮＳＣＥＡＲ报告书（１９８８）的推荐值相比，室内值相同，室外值略高，与Ｊａｃｏｂｉ的研究相近。由此可得出结论，福州地区引用ＵＮＳＣＥＡＲ报告书的推荐值来估算氡及其子体所致肺剂量是合适的。此结论能否推广到其他地区，还需作进一步的研究。     

ABS-2000全自动血库系统临床应用评价研究

目的:通过相应的测定对自动化血库系统适用性和安全性进行全面评价,并对输血相容性检测方法与常规手工方法进行全面对比.方法:使用人工设计的各种样本对仪器进行特异性、灵敏度及抗干扰试验的对比评估,以及对临床常规9108例标本进行ABO正反定型,Rh(D)测定及抗体筛检测定,并对相应结果进行对比分析.结果:对人工设置的各种测定标本,在特异性、灵敏度和抗干扰试验中,测定结果均能达到设计要求,并优于手工Polybrene方法.ABO血型测定9108份,除正反定型不符.228份,报告NTD给予提示外,其它测定血型全部与报告血型相符;Rh(D)所测结果为4份NTD,9104份结果全部相符.抗体筛检测定9108份,抗筛阳性383份,使用同一种抗筛细胞进行手Polybrene方法抗筛测定阳性仅为228份,统计学有显著性意义(P＜0.005).结论:ABS2000应用的固项检测技术具有较高的敏感度,能检测出较弱的IgG类的不规则及自身抗体,以上检测结果及统计情况与国外相关报道情况相符,此仪器在临床检测中使用可以达到保证安全检测的目的.     

电子时代的医学图书馆馆员和循证医学

简要阐述了循证医学的概念及其基本特点,探讨了电子时代循证医学对于医学图书馆员的要求,同时提出了电子时代医学图书馆员应该具备的知识和技能.     

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.     

Don’t Let an Opportunity Go by: Validation of the EIGHT Gambling Screen

The EIGHT Screen is a brief problem gambling screen originally designed for use by family doctors. Its wider use indicated the need for further validation. A triangulated approach used a range of measures in different settings in both the current study and findings from a number of earlier projects, and reviewed current use. The EIGHT Screen had acceptable correlations with the SOGS (r = 74–90%) and with the NODS-12 months Screen (r = 62.4%). Measurements remained relatively constant amongst a range of cultures, settings, age and gender, while few false positives were produced by the screen. The EIGHT Screen appears to be a valid tool for untrained users to identify Level 2 and 3 problem gambling in a wide range of cultures and settings.