Prevalência de comorbidades em pacientes com megaesôfago chagásico / Prevalence of comorbidities in patients with chagasic megaesophagus

ABSTRACT Objective: This study aimed to evaluate the prevalence of some epidemiologically important comorbidities in patients with Chagas megaoesophagus in relation to the population without megaoesophagus, and whether this condition would be a protective or a risk factor for the conditions analysed. Methods: This observational descriptive study collected data from the medical records of patients with a previous diagnosis of megaoesophagus (timing: from 2005 to 2020). The patients were divided by age into a general (all ages) and an older group (aged 60 years or more). Associations were searched for four main areas/systems/involvements: cardiovascular, respiratory, endocrine and neurological. Results: The general group included 546 patients and the older group included 248 patients. As for the prevalence of comorbidities in the general group, the three most prevalent diseases were hypertension, with 44.3% (CI95%: 40.21-48.51%); dyslipidaemia, with 17.8% (CI95%: 14.79-21.19%); and heart failure, with 15.2% (CI95%: 12.43-18.45%). Similar to that in the general group, the most prevalent comorbidities in the group of older patients were hypertension, dyslipidaemia, and heart failure. Conclusion: Systemic arterial hypertension, dyslipidaemia, and heart failure were the most prevalent comorbidities in this population. The lower prevalence of diabetes mellitus and Alzheimer's disease suggests the association of enteric nervous system denervation and requires further investigation.

RESUMO Objetivo: Este estudo teve como objetivo avaliar a prevalência de algumas comorbidades epidemiologicamente importantes em pacientes com megaesôfago chagásico em relação à população sem o megaesôfago e se essa condição seria um fator protetor ou de risco para as condições analisadas. Métodos: Este estudo descritivo observacional coletou dados de prontuários de pacientes com diagnóstico prévio de megaesôfago (período: de 2005 a 2020). Os pacientes foram divididos por idade em um grupo geral (todas as idades) e um grupo idoso (60 anos ou mais). Foram pesquisadas associações para quatro áreas/sistemas/envolvimentos principais: cardiovascular, respiratório, endócrino e neurológico. Resultados: O grupo geral incluiu 546 pacientes e o grupo idosos incluiu 248 pacientes. Quanto à prevalência de comorbidades no grupo geral, as três doenças mais prevalentes foram hipertensão, com 44,3% (IC95%: 40,21-48,51%); dislipidemia, com 17,8% (IC95%: 14,79-21,19%); e insuficiência cardíaca, com 15,2% (IC95%: 12,43-18,45%). Assim como no grupo geral, as comorbidades mais prevalentes no grupo de idosos foram hipertensão, dislipidemia e insuficiência cardíaca. Conclusão: Hipertensão arterial sistêmica, dislipidemia e insuficiência cardíaca foram as comorbidades mais prevalentes nessa população. A menor prevalência de diabetes mellitus e doença de Alzheimer sugere uma associação de denervação do sistema nervoso entérico e requer mais investigação.

Self-efficacy of Filipino physicians towards research and research utilization: A single-center quantitative descriptive survey

@#<p style="text-align: justify;"><strong>Research Question:</strong> What is the current status of self-efficacy beliefs towards research and research utilization (RU) of University of Santo Tomas Faculty of Medicine and Surgery (UST-FMS) graduates who had Clinical Epidemiology in their basic medical education curriculum?</p><p style="text-align: justify;"><strong>Significance of the Study:</strong> There is an increase in research and RU trends globally as adherence to practice based on evidence results in improved patient outcomes. Limited studies are available in describing research and RU of Filipino physicians and there is no study available specific for UST-FMS graduates.</p><p style="text-align: justify;"><strong>Objectives:</strong> The study aims to describe self-efficacy beliefs towards research and RU of UST-FMS graduates' batches 2012-2016 who had Clinical Epidemiology in their basic medical education.</p><p style="text-align: justify;"><strong>Study Design:</strong> A single-center, quantitative descriptive survey design was used.</p><p style="text-align: justify;"><strong>Methodology:</strong> Participants were graduates of UST-FMS batches 2012-2016, currently working at the University of Santo Tomas Hospital. Evidence-based Practice Confidence Scale (EPIC scale) and Edmonton Research Orientation Survey (EROS) were used to assess the research and RU of the participants gathered through snowball sampling.</p><p style="text-align: justify;"><strong>Statistical Analysis:</strong> Descriptive statistics such as means and standard deviations were used to analyze the EPIC and EROS scores.</p><p style="text-align: justify;"><strong>Results:</strong> The UST-FMS graduates value research and are generally confident in their ability to participate in evidence-based medicine. However, they rarely conduct research and have a low understanding of statistics.</p><p style="text-align: justify;"><strong>Conclusion:</strong> The self-efficacy beliefs of USTFMS graduates towards research and RU may be attributed to several factors. Clinical epidemiology as a subject may be improved by adding more lectures on statistics while hospitals should create avenues to support the conduct of research.</p>

2 ． Overview of the DeSC Database and Utilization for Clinical Epidemiology and Pharmacoepidemiology Research / 薬剤疫学

Studies using real-world data are recently increasing worldwide. Various types of real-world data are available in Japan. Administrative claims databases include the National Database (NDB) and other types of databases including several commercially available databases. This article describes the DeSC database, newly constructed by DeSC Healthcare Co., Ltd. in 2020. One of the features of the DeSC database is that it includes data from the National Health Insurance, Health Insurance, and Advanced Elderly Medical Service System. In the present article, we referred to our previous study on population representativeness of the DeSC database and explained its overview. Estimated prevalence of some diseases were described for each type of insurance. Furthermore, we discussed the use of the DeSC database for clinical epidemiology and pharmacoepidemiology research.

Differentiated thyroid cancer clinical trends in Quito, Ecuador / Tendencias clínicas del cáncer diferenciado de tiroides en Quito, Ecuador

Introduction.Thyroid cancer is currently the first most common cancer in women in Ecuador. This study aimed to assess the changes in clinical presentation and diagnosis of differentiated thyroid cancer at a third level hospital in Quito, Ecuador.Methods and Materials.This is a retrospective case series performed in three consecutive periods from 1990 to 2019 at a tertiary level hospital, in Quito, Ecuador. The clinical records of 875 patients who had been diagnosed and surgically treated for differentiated thyroid cancer were reviewed. Demographic, clinical, imaging, and pathological data were collected and analyzed.Results. Significant trends toward older age, higher educational level, less palpable primary tumors, less palpable neck nodes, less distant metastases, more ultrasound, tomography and cytology exams, smaller primary tumors, more stage I patients, and more histological variant description, were found. Introduction.Thyroid cancer is currently the first most common cancer in women in Ecuador. This study aimed to assess the changes in clinical presentation and diagnosis of differentiated thyroid cancer at a third level hospital in Quito, Ecuador.Methods and Materials.This is a retrospective case series performed in three consecutive periods from 1990 to 2019 at a tertiary level hospital, in Quito, Ecuador. The clinical records of 875 patients who had been diagnosed and surgically treated for differentiated thyroid cancer were reviewed. Demographic, clinical, imaging, and pathological data were collected and analyzed.Results. Significant trends toward older age, higher educational level, less palpable primary tumors, less palpable neck nodes, less distant metastases, more ultrasound, tomography and cytology exams, smaller primary tumors, more stage I patients, and more histological variant description, were found.

Introducción. El cáncer de tiroides es actualmente el cáncer más frecuente en la mujer en Ecuador. El presente estudio ha tenido como objetivo evaluar los cambios en la presentación clínica y el diagnóstico del cáncer diferenciado de tiroides en un hospital de tercer nivel de Quito, Ecuador. Material y Métodos. El presente es un estudio retrospectivo de casos realizado en tres períodos consecutivos desde 1990 a 2019 en un hospital del tercer nivel en Quito, Ecuador. Los expedientes clínicos de 875 pacientes tratados quirúrgicamente por un cáncer diferenciado de tiroides fueron revisados. Los datos demográficos, clínicos, de imagen y patología fueron extraídos y analizados. Resultados. Se encontraron tendencias significativas hacia una edad más avanzada, nivel educativo más alto, menos tumores palpables, menos adenopatías regionales palpables, menos metástasis a distancia, más exámenes de ultrasonido y tomografía, más estudios de citología, más tumores pequeños y pacientes con estadío I y más descripciones de las variantes histológicas. Conclusiones. El cáncer de tiroides no sólo que ha aumentado continuamente en su frecuencia en los años recientes, sino que la presentación clínica, el manejo diagnóstico y terapéutico ha cambiado significativamente en las tres últimas décadas.

Fenotipos clínicos de la enfermedad pulmonar obstructiva crónica en los pacientes atendidos en el Hospital neumológico de La Habana / Clinical phenotypes of chronic obstructive pulmonary disease in patients treated at the Hospital Neumológico de La Habana

Introducción: La identificación de los fenotipos clínicos son claves en la modulación de la expresión clínica, para un tratamiento integrado de la EPOC. Objetivos: Caracterizar los fenotipos clínicos de la EPOC en los pacientes atendidos en el Hospital Neumológico Benéfico Jurídico. Métodos:Se realizó un estudio observacional descriptivo retrospectivo, en 172 pacientes con diagnóstico de EPOC, en el Hospital Neumológico Benéfico Jurídico durante el año 2017.Resultados: El 38,4 % de los pacientes tenían edad entre 70-79 años. Del total de pacientes, el 54,6 % eran del sexo masculino. El 52,9 % eran fumadores activos y el 41,3 % exfumadores. Aunque las diferencias no fueron significativas, la edad avanzada y el sexo masculino fueron más frecuentes en el fenotipo enfisematoso agudizador y agudizador bronquítico crónico. El tabaquismo activo fue más frecuente en el fenotipo enfisematoso agudizador. Todos los pacientes con el fenotipo agudizador bronquítico crónico tuvieron dos o más exacerbaciones, mientras que el enfisematoso agudizador se relacionó con una severidad grave de la EPOC (46,7 %). Conclusiones: El sexo masculino y la edad avanzada muestran una tendencia a relacionarse con el fenotipo enfisematoso agudizador y agudizador bronquítico crónico, mientras que el tabaquismo activo es más frecuente en el fenotipo enfisematoso agudizador. El fenotipo agudizador bronquítico crónico se relaciona con mayores exacerbaciones y el enfisematoso agudizador con una mayor severidad de la EPOC.

Introduction: The identification of clinical phenotypes are key in the modulation of clinical expression, for an integrated treatment of COPD. Objectives: To characterize the clinical phenotypes of COPD in patients treated at the Hospital Neumológico Benéfico Jurídico. Methods: A retrospective descriptive observational study was carried out in 172 patients with a diagnosis of COPD at the Hospital Neumológico Benéfico Jurídico in 2017. Results: 38.4 % of the patients were between 70-79 years of age. Of the total number of patients, 54.6 % were male. 52.9 % were active smokers and 41.3 % ex-smokers. Although the differences were not significant, advanced age and male sex were more frequent in the exacerbator emphysematous and chronic bronchial exacerbator phenotype. Active smoking was more frequent in the exacerbating emphysematous phenotype. All patients with the chronic bronchial exacerbator phenotype had two or more exacerbations, while exacerbation emphysematous was associated with severe severity of COPD (46.7 %). Conclusions: Male sex and advanced age show a tendency to be related to the exacerbating emphysematous phenotype and chronic bronchitis exacerbator, while active smoking is more frequent in the exacerbating emphysematous phenotype. The chronic bronchitis exacerbator phenotype is related to greater exacerbations and exacerbation emphysematous with a greater severity of COPD

Caracterización clínico epidemiológica de pacientes en edad pediátrica ingresados en centros de aislamiento de Cienfuegos / Clinical-epidemiological characterization of pediatric patients admitted to isolation centers of Cienfuegos province

Introducción: La población pediátrica no ha sido las más vulnerable a laCOVID-19. La vigilancia epidemiológica estricta y las estrategias tomadas, permiten identificar y realizar análisis clínico epidemiológico en esta población. Objetivo: Caracterizar desde la óptica clínica y epidemiológica a pacientes pediátricos ingresados en centros de aislamiento. Métodos: Estudio descriptivo y transversal en 316 infantes sospechosos de contactos de personas con COVID-19, edades entre 1 y 18 años e ingresados en los centros de aislamiento de Cienfuegos, desde el 11 de marzo al 30 de junio de 2020.Las variables: edad, sexo, casos sospechosos o contactos, mes de ingreso, sintomatología clínica y casos confirmados. Los datos se expresaron en valores absolutos y relativos. Resultados: Fueron sospechosos 36,7 por ciento niños, 63,3 por ciento contactos; 96,9 por ciento fueron remitidos desde sus áreas de salud. Solo 5 (1,6 por ciento) niños fueron confirmados con la enfermedad y todos tuvieron evolución favorable. Predominaron las edades de 5 a 9 años y de 15 a 18 años con 24,4 y 24,7 por ciento, respectivamente, sin diferencia de género;64,9 por ciento fueron asintomáticos. Los síntomas clínicos más frecuentes fueron: tos (56,8 por ciento) y fiebre (55,9 por ciento). Solo 9 (8,1 por ciento)con dificultad respiratoria. Conclusiones: La enfermedad en la población pediátrica de la provincia Cienfuegos no constituye un problema de salud por el bajo porcentaje de niños confirmados con la enfermedad en los centros de aislamiento. Se reafirma que una de las formas de transmisión es de hombre a hombre y es el aislamiento fundamental para el control y diagnóstico(AU)

Introduction: The pediatric population has not been the most vulnerable to COVID-19. Strict epidemiological surveillance and the strategies taken, allow to identify and perform a clinical-epidemiological analysis in this population. Objective: Characterize from the clinical and epidemiological points of view pediatric patients admitted to isolation centers. Methods: Descriptive and cross-sectional study of 316 infants who were suspected cases or contacts of people with COVID-19, in ages from 1 to 18 years and who were admitted to the isolation centers of Cienfuegos province, from March 11 to June 30, 2020. The variables used were: age, sex, suspected cases or contacts, month of admission, clinical symptomatology, and confirmed cases. The data were expressed in absolute and relative values. Results: 36.7 percent children, and 63.3 percent contacts were suspected; 96.9 percent were referred from their health areas. Only 5 (1.6 percent) children were confirmed with the disease and all had favorable evolution. The ages from 5 to 9 and from 15 to 18 years predominated with 24.4 percent and 24.7 percent, respectively, without gender difference; 64.9 percent were asymptomatic. The most common clinical symptoms were: cough (56.8 percent) and fever (55.9 percent). Only 9 patients (8.1 percent) had respiratory distress. Conclusions: This disease in the pediatric population of Cienfuegos province is not a health problem because of the low percentage of children confirmed with the COVID-19 in isolation centers. It is confirmed that one of the forms of transmission is person-to-person and isolation is vital for control and diagnosis(AU)

A Single-center Retrospective Analysis of Clinical Epidemiology of Multiple Sclerosis / 中山大学学报(医学科学版)

@# 【Objective】To summarize current situation of multiple sclerosis in South China and provide reference for MS diagnosis and treatment.【Methods】We selected patients of whom the first diagnosis was MS from 2011 to March 2019，and divided them into Adults group and Pediatrics group according to onset age above or below 14. We analyzed them from epidemiology，symptomatology，accessory examinations and treatment situation.【Results】296 patients were admitted into this research. The ratio of male to female was 1∶1.67. Median onset age was 26. Relapsing-remitting MS accounted for 63.2% of all patients. For initial episode，130 patients had motor symptoms（43.9%），118 patients showed sensory symptoms（39.9%），and 55 patients were accompanied with visual symptoms（18.6%）. Statistical difference exists in sensory symptoms（114 vs. 4，Z = -2.155，P = 0.031）and paroxysmal symptoms（4 vs. 3，Z = -3.610，P = 0.000） of Adults group and Pediatrics group. For following episodes，the total relapsing time was 712，with motor symptoms relapsing 380 times（53.4%），sensory symptoms 265 times（37.2%）and visual symptoms 134 times（18.8%）. Statistical difference existed in motor，sensory，visual，other ocular symptoms and paroxysmal symptoms. Positive rate of Oligoclonal bond was 45.5%. Positive rate of MOG-Ab was 16.7%. For brain MRI，periventricular lesions ≥ 9 accounted for 57.4% of all patients，with cortical & juxtacortical lesions 28.1% and infratentorial lesions 0.3%. Patients who had optic nerve lesions accounted for 63.2%. No statistical difference existed in them. For treatment，drugs they had used previously were glucocorticoid（79.7%），beta Interferon（15.9%）and azathioprine（13.9%）.During the study，drugs they were using were glucocorticoid（15.5%），rituximab（9.1%），azathioprine（8.1%）and teriflunomide（8.1%）.【Conclusions】For gender， age，symptomatology and accessory examinations，results of this research are similar to previous papers about multiple sclerosis in Asian. For treatment，the trend indicates that usage of new disease-modifying drugs goes up.

Implementation of literature case study in clinical epidemiology teaching reformation for medical students of the eight-year medical education program / 基础医学与临床

In order to improve the teaching quality of clinical epidemiology for medical students engaged in eight-year curriculum of Peking Union Medical College, and foster the practice of evidence-based medicine and clinical research in Peking Union Medical College Hospital (PUMCH), the Clinical Epidemiology Unit of PUMCH(PUMCH-CEU) utilized successful experience from institutions abroad and conducted a teaching reform. In addition to theory teaching, PUMCH-CEU incorporated literature case study and assignments into the course, so as to improve students' understanding about the design, measurement, and evaluation of clinical research. The execution of a well-designed reformation plan has led to a great success of this course, as well as fruitful achievements.

The clinical epidemiology of preterm infants / 国际儿科学杂志

Preterm birth is the core issue of neonatology and perinatology researches,and the incidence of preterm birth increasing overall in recent years.With the development of modem health care,preterm birth survival rate has been increasing to some extent,while the prognosis is poor because of serious complications.Epidemiological studies of preterm birth is essential for improving the diagnosis and treatment of premature infants,and this summary introduces the clinical epidemiology of preterm birth through the definition,incidence,related factors,major complication and so on.

Evaluation on effectiveness of prevention in clinical epidemiology teaching for the students in clinical medicine / 中华医学教育探索杂志

Objective To study the teaching effect of prevention in clinical epidemiology teaching.Methods 187 clinical medical students of Grade 2010 from China Medical University were selected as the research objectives.2 teaching hours of prevention content was increased in the clinical epidemiology teaching,and the anonymous questionnaire survey was used to assess the teaching effectiveness.A total of 187 questionnaires were issued and 187 valid questionnaires were collected.All the data were analyzed by SPSS 16.0.Results 82.9％ (155 people) of the students believed that the addition of preventive content was necessary,40.1％ (75 people) of the students believed that there was a significant increase in the content of the prevention.For the understanding of the content,only 11.2％ (21 people) of the students said they had a complete understanding of the class,but after teaching 51.3％ (96 people) of the students expressed a clear understanding of the content.82.4％ (154 people) of the students thought that the teaching contents of prevention was tightly combined with the clinical,and 74.9％ (140 people) of the students thought that 2 hours setting was appropriate.Students' demands for prevent content also included:1) how to strengthen prevention in daily life;2) tumor disease prevention,including current international popular tumor vaccine;3) of emergent public health event instance;4) occupational disease prevention measures,etc.Conclusion Increasing the contents of prevention in the clinical epidemiology teaching has made students of clinical medicine change their clinical concept and realize the key role of prevention in clinical treatment.At the same time,this study understands students' needs for the content of prevention,and provides a basis for the setting and op-timization of clinical epidemiology course in the future.

How to understand and conduct evidence-based medicine / 대한마취과학회지

Evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions regarding the care of individual patients. This concept has gained popularity recently, and its applications have been steadily expanding. Nowadays, the term "evidence-based" is used in numerous situations and conditions, such as evidence-based medicine, evidence-based practice, evidence-based health care, evidence-based social work, evidence-based policy, and evidence-based education. However, many anesthesiologists and their colleagues have not previously been accustomed to utilizing EBM, and they have experienced difficulty in understanding and applying the techniques of EBM to their practice. In this article, the author discusses the brief history, definition, methods, and limitations of EBM. As EBM also involves making use of the best available information to answer questions in clinical practice, the author emphasizes the process of performing evidence-based medicine: generate the clinical question, find the best evidence, perform critical appraisal, apply the evidence, and then evaluate. Levels of evidence and strength of recommendation were also explained. The author expects that this article may be of assistance to readers in understanding, conducting, and evaluating EBM.

Aproximación epistemológica a las ciencias que soportan las prácticas basadas en la evidencia: anotaciones críticas / Epistemological approach to the sciences that support evidense-based practice / Aproximação epistemológica às ciências que suportam as práticas baseadas na evidência: anotações críticas

Presentamos en este artículo de reflexión un abordaje epistemológico a las disciplinas científicas que soportan las prácticas basadas en la evidencia: para ello se toma como modelo a la epidemiología clínica como proveedora de conocimiento para la medicina que basada en la evidencia. Se problematiza la idea de progreso que plantean estas prácticas en su enunciación. Se resaltan las inconveniencias de la importación ciega de los métodos de la física y la química para estudiar los fenómenos de la vida (lo humano allí incluido). Además se revisa críticamente la definición del objeto de la epidemiología clínica (el enfermo) subrayando algunas deficiencias en su marco conceptual. Se concluye planteando las limitaciones que esta propuesta presenta, lo cual disminuye su alcance explicativo y su coherencia interna.

We present in this reflection article, an epistemological approach to scientific disciplines that support evidence-based practices: for it, the clinical epidemiology modeled was selected as a provider of knowledge to evidence-based medicine.The idea of progress proposed by these practices in their enunciation is problematized. The inconveniences of blind import methods of physics and chemistry to study the phenomena of the life (human there included) are highlighted. Also,a critically review of the definition of the object of clinical epidemiology (the patient) highlighting some shortcomings in its conceptual framework. We conclude by asking the limitations in this proposal, which decreases its explanatory scope and internal consistency.

Apresentamos neste texto de reflexão uma abordagem epistemológica das discipli-nas científicas que suportam as práticas baseadas na evidência: para tanto, se toma como modelo à epidemiologia clínica como provedora de conhecimento para a medicina baseada na evidência. Problematiza se a ideia de progresso que propõem essas práticas em seu enunciado. Ressaltam-se as inconveniências da importação cega dos métodos da física e da química para estudar os fenómenos da vida (o humano aí incluso). E se revisa criti-camente a definição do objeto da epidemiologia clínica (o enfermo) sublinhando algumas deficiências em seu marco conceitual. Conclui-se propondo as limitações que esta proposta apresenta, o que diminui seu alcance explicativo e sua coerência interna.

Satisfaction evaluation on teaching of clinical epidemiology among medical postgraduates / 中华医学教育探索杂志

Objective Our purpose was to evaluate the teaching satisfaction of clinical epi-demiology among medical postgraduate and to come up with measures for further improvement of teaching quality. Methods A self-administered questionnalre was given to all the medical postgradu-ates and doctoral students of Grade 2013 by cluster sampling when they finished the course of clinical epidemiology. A total of 559 graduate students, including 324 graduate students (58%), 235 doctoral students (42%), recruitment graduate students 350 (62.6%), on-the-job graduate student 209 (37.4%).The contents of the questionnalre included many aspects such as the investigation object in general, teaching materials evaluation satisfaction, curriculum and teacher satisfaction evaluation. Respondents ' self-administered manner was adopted. Parallel input was done by using Epidata software; data were analyzed with SPSS 19.0 software, continuous variable was made by x±s, categorical variables was expressed by n(%). Continuous variables were compared among groups by t test and analysis of vari-ance. Classification grouping variable was compared by chi-square test, and P<0.05 for the difference was statistically significant . Results Overall evaluation of theory was below that of the internship teaching materials. The satisfaction rate of practicability, meeting the learning needs and difficulty degree for theory and practice teaching material were 83.7% (468/559), 87.5% (489/559), 67.1% (375/559) and 92.7%(518/559), 89.6%(501/559), 83.0%(464/559) respectively. 41.6%(87/209) of on-the-job students and 36.7% (119/324) of postgraduates considered theory teaching material was difficult for them. The satisfaction rate for faculty teaching attitude (99.5%, 556/559), faculty teaching method (98.6%,551/559), the theories combining with practice teaching method (97.5%, 545/559) were high, but the satisfaction rate for teaching hours was low (67.4%, 377/559), with one third students consider more hours for the course. Conclusion The Teaching effect of clinical epidemiology is falrly good in our school. The postgraduates are satisfied with the teaching materials, curriculum setting, and teach-ing faculty. But there are also some shortcomings. In the future teaching work, we should appropriately increase the hours, and set corresponding teaching contents and methods according to the different learning characteristics of the on-the-job graduate students and recruitment graduate students, to improve the teaching effect and teaching quality.

Awareness of septic acute kidney injury in children / 临床儿科杂志

This paper describes the clinical epidemiologic features, main pathogenesis, early diagnostic biomarkers and managements of septic acute kidney injury in children. It is suggested that pediatric clinicians should increase awareness of the treatment of septic acute kidney injury in children.

Perfil clínico, epidemiológico y radiológico de la neumonía en el adulto mayor. Servicio de Geriatría del Hospital Almanzor Aguinaga Asenjo, julio 2010-julio 2011 / Clinical, epidemiological and radiological profile of pneumonia in the elderly. Geriatrics Department of Hospital Almanzor Aguinaga Asenjo, July 2010-July 2011

Objetivo: Describir el perfil clínico, epidemiológico y radiológico de la neumonía en el adulto mayor. Servicio de Geriatría del Hospital Nacional Almanzor Aguinaga Asenjo, Julio 2010 ­ Julio 2011. Material y Método: Estudio descriptivo transversal, se evaluaron 56 historias clínicas de los pacientes adultos mayores con diagnóstico de neumonía en el periodo Julio 2010 ­ Julio 2011. Resultados: población de pacientes mayormente de sexo femenino (73,2%) y un grupo etáreo de 86 a 90 años (41,1%), la mayoría con infrapeso (62,5%) y dependencia física (69,6%).La forma de atención principalmente fue como ingreso referido (55,4%) y lugar de ingreso por emergencia (78,6%). En el perfil clínico, la comorbilidad respiratoria más importante fue EPOC (26,79%) y la HTA (62,5%). La neumonía adquirida en la comunidad fue la más frecuente con 73% de los casos, siendo la forma severa la predominante (66,1%). Los signos y síntomas más frecuentes fueron fiebre (94,75%), tos (94,64%) y expectoración (83,93%). Radiológicamente, se muestra predominio del patrón alveolar y de extensión bilateral (ambos con 48,21%). Conclusiones: Los adultos mayores con neumonía son de mayor frecuencia de procedencia de Chiclayo, sexo femenino, 86 a 90 años, con infrapeso, dependencia física y no presentan vacunación contra Influenza ni contra Neumococo, referido por emergencia, comorbilidad respiratoria de EPOC y no respiratoria de hipertensión arterial. La fiebre, tos, expectoración fueron los signos y síntomas más frecuentes y radiológicamente predominio del patrón alveolar y extensión bilateral.(AU)

<b>7. Example of Healthcare Database Utilization: The Diagnosis Procedure Combination Database </b> / 薬剤疫学

The Diagnosis Procedure Combination(DPC) is a case-mix classification system for hospitalized patients, which is linked with lump-sum payment system called the Diagnosis Procedure Combination/Per-Diem Payment System(DPC/PDPS). The DPC Study Group works on the DPC data utilization project for research purpose, independently of Ministry of Health, Labour and Welfare, Japan. The database contains discharge data and administrative claim data, including diagnoses, comorbidities and complications coded with ICD-10(International Classification of Diseases and Related Health Problems, Tenth Revision) codes; procedures; duration of anesthesia; volume of blood transfusion; drugs and devices used; length of stay; discharge status; costs; and detailed clinical information(body height/weight; smoking index; Japan Coma Scale; cancer stage; modified Rankin Scale; Hugh-Johns classification; NYHA classification for heart failure, severity index for angina pectoris/myocardiac infarction, pneumonia, and acute pancreatitis; and Child-Pugh classification for liver cirrhosis). In this report, we introduced two studies using the DPC database: (i) the effect of fondaparinux on the prophylaxis of postoperative pulmonary embolism and (ii) the effect and cost of gabexate mesylate on the treatment of acute pancreatitis. In addition, we compared the DPC database with the US administrative databases(including the Nationwide Inpatient Sample database and the Medicare claim database) and discussed the tasks for the future set to the DPC database to further enhance clinical studies and health services research in Japan. (Jpn J Pharmacoepidemiol 2012; 17(2): 163-169)

Perspectives of clinical epidemiology in Korea

The establishment of clinical epidemiology has meant the improvement of the quality and quantity of clinical science because clinical epidemiology has contributed to the process of decision making across the full scope of clinical practice, including diagnosis, treatment, and care, as well as prevention. Epidemiological and statistical methodologies have been used to analyze scientific evidence on clinical problems. The orientation of evidence-based medicine introduced in the mid-1990s is the application of clinical epidemiology to clinical practice for individual patients. The concept of evidence-based medical practice has triggered the expansion of the scope and range of methods of clinical epidemiology. In spite of the global situation, the formal activity in the area of clinical epidemiology in Korean Medical Academic Association is negligible, with few clinical epidemiologists involved. One of several approaches to stimulating the practice of clinical epidemiology in Korea would be to foster clinical epidemiology as a specialization of clinical preventive medicine, which is one of the sub-specialties of preventive medicine in Korea.

Need analysis of clinical research consultation for clinical epidemiology in a general hospital / 中华医学科研管理杂志

Objective To understand the needs for and supply of clinical research consultation at the clinical epidemiological unit (CEU) in a general hospital. Methods Data were collected from work records of 2008 of CEU and were analysed. Results There were three faculties and three graduate students in the CEU, who altogether provided 272 consultations in 2008. 147 of the consultants were doctors (54.0%), and 90 were graduate students (33.1%). With regard to the content of consultation, 106 (39. 0%) were for bio-statistical methods, 96 (35. 3%) for project design, 36(13.2%) for paper writing and 24 (8.8%) for others. The professor of the CEU provided more consultation on project design (71/139, 51.1%) than assistant professors (22/151, 19.1%) and graduate students (3/18, 16.7%) (P＜0.01). The assistant professors (66/151, 57.4%) and graduate students (10/18, 55.6%) provided consultation on bio-statistical methods more than the professor (30/139, 21.6%) (P＜0. 01). Conclusion Doctors and graduate students in the general hospital need clinical research consultation service from the CEU. It is necessary and possible to establish a CEU in general hospital to meet the needs of clinical epidemiological consultation. The free consulting policy is effective in improving the accessibility and satisfaction of the consulting service.

A Report about Training in Clinical Research Program(TICR)at the University of California, San Francisco(UCSF) / 医学教育

1)The primary author completed a one–year program for clinicians, Training in Clinical Research(TICR), at the University of California San Francisco(UCSF).<br>2)In TICR, several educational systems including mentoring and feedback were used.<br>3)The clinicians at UCSF were provided protected time for clinical research and research education.

An epidemiological study on cholelithiasis in the Zunyi region / 中华肝胆外科杂志

ObjectiveTo find out the risk factors and the incidence of lithiasis. MethodsA questionnaire was formulated by the National Biliary Surgical Group. It was sent to the medical staff of all levels of hospitals in the Zunyi Region, Guizhou to fill in on surgically proven cases of cholelithiasis. The clinical data were collected and analyzed using SPSS 13.0. ResultFor lithiasis, the gender ratio was 1∶ 1.78; the peak age was 41-year and 51-year respectively. The proportion of cholecystolithiasis (n =4456 ; 86.76 ％) and choledocholithiasis (n =554;10.79 ％ ) was comparatively higher than in other regions in China. ConclusionsThe commonest type of lithiasis in Zunyi was cholecystolithiasis. There was an increasing tendency for lithiasis to develop in young people. Lithiasis was closely associated with factors such as gender, food and occupation.