摘要:目的:分析本院住院城镇及农村患者的乙型肝炎病毒感染及免疫情况,推测不同区域发病及免疫状况,为免疫预防及临床提供参考。方法:收集我科2000年度,2004年度,2008年度住院患者的乙肝五项检测报告,按患者长期居住地分为农村组及城镇组,对比分析两组患者乙型肝炎病毒感染、具有免疫力及无免疫力年度变化情况及不同组别的差异。结果:同农村组相比,城镇组乙型肝炎病毒感染率、无免疫率低于农村组,免疫率高于农村组。年度对比乙型肝炎病毒感染率及免疫率呈上升趋势,无免疫率呈下降趋势。结论:近年来乙型病毒性肝炎发病有上升趋势,农村地区免疫普及率相对较低,仍为发病及预防免疫的重点区域,应给予足够重视。Abstract: Objective: To observe the disposition of infection and immunifaction on type B hepatitis in patients from hospital, suppose the disposition of infection and immunifaction in differently region, and provide information for immunifaction and clinical treatment. Methods: Reports of type B hepatitis from patients in hospital were collected, and were divided into town group and country group according to the habitation of patients. The difference of infection, immunifaction and no immunifaction were compared between two groups. Results: In comparison with the country group, the percentage of infection and no immunifaction was lower in town, and immunifaction was higher, attack rate of type B hepatitis had a tendency to increasing and no immunifaction was decreased by contrasting with annum. Conclusion: Recent years, attack rate of type B hepatitis has a tendency to increasing, and the popular rate of immunifaction is lower in country, so country is still the focal point of immunifaction and infection, and sufficient attention must be paid.
【摘要】 目的 探讨糖尿病管理的有效模式，提高糖尿病患者的治疗达标率，减少低血糖发生。 方法 研究对象为2008年5月-2009年5月就诊的2型糖尿病患者356例。测量所有研究对象的空腹血糖、餐后2 h血糖、糖化血红蛋白。观察糖尿病管理后及常规治疗后血糖的变化。 结果 应用糖尿病达标管理软件管理糖尿病患者，血糖达标率明显升高，差异有统计学意义（Plt;0.05）；低血糖的发生率下降，差异有统计学意义（Plt;0.05）。 结论 大多数糖尿病患者的病情控制未达到理想的目标，应用科学的糖尿病达标管理软件进行管理是改善现状的有效方法。【Abstract】 Objective To study the effective management model for diabetes mellitus, promote the treatment results of patients with disease, and reduce the occurrence of hypoglycemia. Methods A total of 356 patients with type 2 diabetes mellitus (T2DM) treated from May 2008 to May 2009 were chosen in this study. Fasting bloods glucose, 2-hour postprandial blood glucose and hemoglobin A1c were detected in all the subjects. Then, the change of glucose level for the management group and the common treatment group was observed. Results The glucose-target-rate of patients managed by diabetes management software was significantly higher than patients in the common treatment group (Plt;0.05), and the occurrence rate of hypoglycemia was also significantly lower (Plt;0.05). Conclusions The control of T2DM for most patients is far from satisfaction. The application of scientific disease care software is effective for improving disease control.
ObjectiveTo study the relationship among cholecystectomy/gallbladder disease and bile reflux gastritis.MethodsA retrospective collection of 123 patients with bile reflux gastritis who were diagnosed as outpatients and hospitalized from January 2014 to February 2019 in Shengjing Hospital Affiliated to China Medical University, and 221 patients with non-biliary reflux gastritis at the same period were collected. According to the gallbladder status, the patients were divided into three groups: gallbladder disease, cholecystectomy, and gallbladder disease-free group. The relationship between gallbladder status and bile reflux gastritis was analyzed.ResultsAmong 123 patients with bile reflux gastritis, there were 22 cases (17.89%) with cholecystectomy and 26 cases (21.14%) with gallbladder disease; 221 cases of non-biliary reflux gastritis with cholecystectomy in 7 cases (3.17%) and gallbladder disease in 30 cases (13.57%). Univariate analysis showed that the gallbladder status was different between the bile reflux gastritis group and the non-biliary reflux gastritis group (χ2=21.089, P<0.001). The study showed that the gallbladder status was related to the occurrence of bile reflux gastritis. In contrast, patients with cholecystectomy and gallbladder disease had a higher risk of occurrence than those with no gallbladder disease (OR>1, P<0.012 5). Independent risk factors were considered by logistic multivariate regression analysis, including cholecystectomy, gallbladder disease, and age (P<0.05).ConclusionsThere is a correlation between cholecystectomy/gallbladder disease and bile reflux gastritis. Cholecystectomy and gallbladder disease may be the independent risk factors for bile reflux gastritis.
Objective To analyse the procedure and effectiveness of internal fixation in treatment of displaced radial head fractures. Methods Between August 2005 and May 2009, 35 patients with displaced radial head fractures underwent open reduction and internal fixation with SmartNail® and/or AO mini-plates. There were 28 males and 7 females with an average age of 28.4 years (range, 17-48 years). The injury mechanism included traffic accident in 16 patients, falling in 13, and falling from height in 6. According to Mason classification, 21 fractures were rated as type II, 9 as type III, and 5 as type IV. All fracturs were closed fractures. Six cases complicated by radial neck fractures, 1 case by olecranon fracture, 3 by posterior dislocations of the elbow, 1 by posterior dislocation of the elbow and coronoid process fracture, and 3 by medial collateral ligament injuries. The time from injury to operation was 3 to 7 days. Results Except 1 patient whose incision healed by second intention, healing of incision by first intention was achieved in the other patients. All patients were followed up 12-25 months with an average of 17 months. The average fracture healing time was 10.2 weeks (range, 8-16 weeks). At last follow-up, the average flexion and extension of the elbow was 119° (range, 95-145°). The average arc of forearm rotation was 126° (range, 90-175°). According to elbow functional evaluation criteria by Broberg and Morrey, the results were excellent in 18 cases, good in 13, and fair in 4; the excellent and good rate was 88.6%. Conclusion In treatment of displaced radial head fractures, open reduction and internal fixation can be performed with SmartNail® and/or AO mini-plates based on different fracture types and the short-term effectiveness is satisfactory.
Real world data (RWD) and real world evidence (RWE) have increasingly received wide attention. Patient registry study is an important part of real-world studies using observational design. In this paper, we introduce the concept, classification and application of patient registries, and discuss the planning for a patient registry study and development of registry database, and provide methodological guidance for developing high-quality patient registry studies.
Retrospective database study is an important type of real world study that employ observational designs, which has received wide attention. However, misunderstandings and inappropriate conduct of retrospective database studies are very common. We systematically introduced the concept, features and applications of retrospective database study, as well as discussed the methods to plan a retrospective database study and how to develop a research database. This article is expected to offer guidance for the quality production and appropriate use of retrospective database study.
ObjectiveTo investigate the effects of single-disease quota payment in Chengdu.MethodsThe data of medical insurance in Chengdu from 2009 to 2013 were used to compare changes of average hospitalization expenses, hospitalization days, re-admission rate and so on by establishing a difference-in-difference (DID) model.ResultsThe quota payment policy effectively controlled the overall medical expenses. Drug fee and examination fee were significantly affected (P<0.01). However, the re-admission rate was significantly improved (P<0.10).ConclusionThe implementation of single-disease quota payment in Chengdu controlled the medical expanses growth effectively, but it is necessary to prevent its side effects.
With the increasing improvement of real-world evidence as a research system and guideline specification for pre-market registration and post-market regulatory decision support of clinically urgent drug and mechanical products, identifying an approach to ensure the high quality and standards of real-world data and establishing a basis for the generation of real-world evidence is receiving increasing attention and concern from regulatory authorities. Based on the experience of Boao hope city real-world data research pattern and ophthalmic data platform construction, this paper discussed the "source data-database-evidence chain" generation process, data management, and data governance in real-world study from the special features and necessity of multiple sources and heterogeneity of data, multiple research designs, and standardized regulatory requirements, and provided references for further construction of comprehensive research data platforms in the future.
ObjectivesTo develop a tool to assess the credibility of cohort studies regarding anticoagulants treatment for patients with atrial fibrillation.MethodsMEDLINE, EMbase and CBM databases were retrieved for eligible studies on the methodological quality and credibility of the cohort study. The retrieval period was from inception to December 19th, 2017, and the languages were limited to Chinese and English. Based on the search results, the items on the methodology quality of the research or the credibility of the results were collected. Through brainstorming of the core group, the collected items were expanded and sorted out to a preliminary scale. Furthermore, we conducted 4 rounds of internal expert seminars to discuss and evaluate the preliminary scale content and discuss the scale framework. Finally, we organized domestic authoritative experts to conduct 4 external evaluations on the scale and formed the final scale.ResultsA total of 7 734 literatures were obtained from primary search, in which 17 of which were included. Fifty-five tools with 780 items for the quality assessment of observational studies were collected from the included studies. After removing duplicated keywords with similar meanings, we obtained the " keyword pool” with 46 keywords, which were preliminarily formed 46 items. After discussion of the core group, which aimed to supplement the potential items, eliminate the items irrelevant to methodology, and integrate the items with partial overlapping meanings, a preliminary scale of 43 items was formed. According to the four rounds of internal expert consultative meetings, these items were integrated to form a preliminary scale of 40 items. After further evaluation by four rounds of external expert consultative meetings, a consensus was reached and a scale of 21 items from seven domains (i.e., definition of question, measurement, follow-up, confounder, missing data, statistical analysis, and results assessment) was finally formed.ConclusionsThis study developed an assessment tool for the credibility of the results from the cohort studies regarding anticoagulants treatment in patients with atrial fibrillation, which has practical clinical value. Clinicians can refer to the results of credibility assessment by using this tool to better assist clinical decision-making in clinical practice. In addition, in the preparation of relevant guidelines, this tool can be used to assess the credibility of results from cohort studies.
In order to improve the understanding of pragmatic randomized controlled trial (pRCT), to promote high-quality implementation of such trials, and to provide technical guidance for researchers to conduct such trials scientifically, the working group of China REal world data and studies ALliance (ChinaREAL) hereby develop a technical guidance. The guidance provides technical specifications of pRCT in terms of the concept and scope of application, planning and study design, conduct, data management and quality control, statistical analysis, and ethical issues. It emphasizes that the trial sites and settings, patient population, interventions, controls, outcomes, follow-ups and other factors should be considered when planning and designing. Meanwhile, the guidance recommends that estimation of sample sizes for different types of trial designs should be based on individual pRCTs, and it also provides suggestions for data management, quality control, principles of statistical analysis, analysis requirements for each type of trial designs, and ethical considerations.