浅谈医生的敬畏之心

疾病是复杂多变的,而医学科学还很年轻,在顽强而又脆弱的生命面前,医生应心存敬畏,养成科学严谨的思维,以审慎的态度应用科学技术,避免成为机器的奴隶,同时要以足够的敬畏精神关注生命,关注人,矫正重疾病轻人文的理念。     

Where Are We Now On Cultural Economics

A survey of progress in cultural economics since its virtual birth in 1966 with the publication of Baumol and Bowen, Performing Arts: The Economic Dilemma , distinguishing between 'theoretical progress' and 'empirical progress'. Following in the footsteps of Towse's recent anthology of classic papers in cultural economics, I address nine topics that between them cover the subject, namely, (1) taste and taste formation, (2) demand and supply studies, (3) the media industries, (4) the art market, (5) the economic history of the arts, (6) the labour market for artists, (7) Baumol's cost disease, (8) non‐profit arts organisations, and (9) public subsidies to the arts. I conclude that there has been some theoretical and empirical progress in the treatment of almost all these topics.     

早期帕金森疾病脑电信号的复杂度分析

为了研究早期帕金森疾病脑电活动异常,记录了27名帕金森早期病人和27名年龄匹配的健康对照组在静息状态下的20导EEG信号。采用排序熵和规则性指数,刻画了2组脑电图数据的复杂性特征。与对照组相比,早期帕金森病人的排序熵降低,规则性指数升高,表明静息状态下帕金森早期组的EEG复杂度低于健康对照组。研究发现,排序熵和规则性指数能有效地刻画帕金森疾病脑电信号的复杂度异常,可为该疾病的早期检测提供一项有效的生物标记。     

上海金山区社区药学报务需求状况的调查

为了解社区居民药学服务的需求状况,更好地为居民提供有效的药学服务。上海市食品药品监督管理局金山分局在上海金山区社区居民中开展了一项有关慢性病药物使用情况调查。调查数据的分析显示,社区药学服务需求满足程度较低,居民接受健康教育和定期体检的意识不强,药学服务有待进一步加强。社区应建立健康档案网络平台,增加社区居民健康培训和健康体检活动频次。药监部门应加大不合格药品和保健品的查处力度。     

A case-control comparison of direct healthcare-provider medical costs of chronic idiopathic constipation and irritable bowel syndrome with constipation in a community-based cohort

Objective: Patients with constipation account for 3.1 million US physician visits a year, but care costs for patients with irritable bowel syndrome with constipation (IBS-C) or chronic idiopathic constipation (CIC) compared to the general public have received little study. The study aim was to describe healthcare utilization and compare medical costs for patients with IBS-C or CIC vs matched controls from a community-based sample.

Methods: A nested case-control sample (IBS-C and CIC cases) and matched controls (1:2) for each case group were selected from Olmsted County, MN, individuals responding to a community-based survey of gastrointestinal symptoms (2008) who received healthcare from a participating Rochester Epidemiology Project (REP) provider. Using REP healthcare utilization data, unadjusted and adjusted standardized costs were compared for the 2- and 10-year periods prior to the survey for 115 IBS-C patients and 230 controls and 365 CIC patients and 730 controls. Two time periods were chosen as these conditions are episodic, but long-term.

Results: Outpatient costs for IBS-C ($6,800) and CIC ($6,284) patients over a 2-year period prior to the survey were significantly higher than controls ($4,242 and $5,254, respectively) after adjusting for co-morbidities, age, and sex. IBS-C outpatient costs ($25,448) and emergency room costs ($6,892) were significantly higher than controls ($21,024 and $3,962, respectively) for the 10-year period prior. Unadjusted data analyses of cases compared to controls demonstrated significantly higher imaging costs for IBS-C cases and procedure costs for CIC cases over the 10-year period.

Limitations: Data were collected from a random community sample primarily receiving care from a limited number of providers in that area.

Conclusions: Patients with IBS-C and CIC had significantly higher outpatient costs for the 2-year period compared with controls. IBS-C patients also had higher ER costs than the general population.     

Burden of illness associated with sinusoidal obstruction syndrome/veno-occlusive disease in patients with hematopoietic stem cell transplantation

Aims: Sinusoidal obstruction syndrome (SOS) is a life-threatening complication of hematopoietic stem cell transplantation (HSCT) associated with significant morbidity and mortality. Healthcare utilization, costs, and mortality were assessed in HSCT patients diagnosed with SOS, with and without multi-organ dysfunction (MOD).

Materials and methods: This retrospective observational study identified real-world patients undergoing HSCT between January 1, 2009 and May 31, 2014 using the Premier Healthcare Database. In absence of a formal ICD-9-CM diagnostic code, SOS patients were identified using a pre-specified definition adapted from Baltimore and Seattle criteria and clinical practice. Severe SOS (SOS/MOD) and non-severe SOS (SOS/no-MOD) were classified according to clinical evidence for MOD in the database.

Results: Of the 5,418 patients with a discharge diagnosis of HSCT, 291 had SOS, with 134 categorized as SOS/MOD and 157 as SOS/no-MOD. The remaining 5,127 patients had HSCT without SOS. Overall SOS incidence was 5.4%, with 46% having evidence of MOD. Distribution of age, gender, and race were similar between the SOS cohorts and non-SOS patients. After controlling for hospital profile and admission characteristics, demographics, and clinical characteristics, the adjusted mean LOS was 31.0 days in SOS/MOD compared to 23.9 days in the non-SOS cohort (medians?=?26.9 days vs 20.8 days, p?p?Limitations: Limitations of retrospective observational studies apply, since the study was not randomized. Definition for SOS was based on ICD-9 diagnosis codes from a hospital administrative database and reliant on completeness and accuracy of coding.

Conclusions: Analysis of real-world data shows that SOS/MOD is associated with significant increases in healthcare utilization, costs, and inpatient mortality.     

Economic burden of comorbid chronic kidney disease and diabetes

Objective: To estimate real-world healthcare utilization and expenditures across the spectrum of chronic kidney disease (CKD), as determined by estimated glomerular filtration rate (eGFR) categories in patients with diabetes.

Methods: This study employed a retrospective cohort study design using the Truven Healthcare and Claims Dataset from 2009–2012. Index date was defined as the first eGFR value during a continuous enrollment period of 24 months. Cohorts of patients were stratified by Kidney Disease: Improving Global Outcomes CKD stage based on eGFR (stages 1: ≥90?mL/min/1.73?m²; 2: 60–89; 3A: 45–59; 3B: 30–44; 4: 15–29; 5: <15). Healthcare expenditures (total patient and payer paid claims) and utilization (number of claims or visits) were estimated 12-months post-index date using generalized linear modeling and negative binomial modeling, respectively, after adjusting for baseline characteristics.

Results: Of 130,098 patients with an index eGFR value and 24-months continuous enrolment, 64,521 (49.59%) were in stage 1 CKD, 47,816 (36.75%) were in stage 2, 13,377 (10.28%) were in stage 3A, 3,217 (2.47%) were in stage 3B, 898 (0.69%) were in stage 4, and 269 (0.21%) were in stage 5. Patients in stages 3A, 3B, and 4 CKD had 1.32 (95% CI?=?1.22–1.43), 1.59 (95% CI?=?1.41–1.80), and 2.65 (95% CI?=?2.23–3.14) times higher rates of diabetes-associated inpatient visits, respectively, compared with stage 1 CKD patients. Patients in stages 3A, 3B, and 4 CKD had increased incremental total annual healthcare expenditures of $1,732 (95% CI?=?$1,109–$2,356), $2,632 (95% CI?=?$1,647–$3,619), and $6,949 (95% CI?=?$5,466–$8,432), respectively, compared with stage 1 CKD patients.

Limitations: The claims data were generated for billing and reimbursement, not for research purposes.

Conclusions: These real-world data suggest an incremental and significant increase in economic burden in diabetes as kidney function declines, starting with moderate (stage 3A) CKD.     

铁缺乏对人体健康的危害

铁是一切生命体不可或缺的必需元素，与人体健康的关系甚为密切。文章在简要介绍铁元素生物学功能的基础上，着重阐述铁缺乏对人体健康的危害，并针对补铁提出了一些建议。     

Cost-impact of cardiac magnetic resonance imaging with Fast-SENC compared to SPECT in the diagnosis of coronary artery disease in the U.S

Aims: The purpose of this study is to assess the economic cost differences and the associated treatment resource changes between the developing coronary artery disease (CAD) diagnostic tool fast strain-encoded cardiac imaging (Fast-SENC) and the current commonly used stress test single-photon emission computed tomography (SPECT).

Materials and methods: A “payer perspective” model was created first, consisting of long-term and short-term components that used a hypothetical cohort of patients of average age (60.8?years) presenting with chest pain and suspected CAD to assess cost-impact. A cost impact model was then built that assessed likely savings from a “hospital perspective” from substituting Fast-SENC for a portion of SPECTs assuming an average number of annual SPECT tests performed in US hospitals.

Results: In the payer model, using Fast-SENC followed by coronary angiography (CA) and percutaneous coronary intervention (PCI) treatment when necessary is less costly than the SPECT method when considering both direct and indirect costs of testing. Expected costs of the Fast-SENC were between $2,510 and $2,632 per correct diagnosis, while expected costs for the SPECT were between $3,157 and $4,078. Fast-SENC reduced false positives by 50% and false negatives by 86%, generating additional cost savings. The hospital model showed total costs per CAD patient visit of $825 for SPECT and $376 for Fast-SENC.

Limitations: Limitations of this study are that clinical data are sourced from other published clinical trials on how CAD diagnostic strategies impact clinical outcome, and that necessary assumptions were made which impact health outcomes.

Conclusion: The lower cost, higher sensitivity and specificity rates, and faster, less burdensome process for detecting CAD patients make Fast-SENC a more capable and economically beneficial stress test than SPECT. The payer model and hospital model demonstrate an alignment between payer and provider economics as Fast-SENC provides monetary savings for patients and resource benefits for hospitals.     

动物疫病风险对规模猪场数智技术应用的影响

[目的]研究动物疫病风险对规模生猪养殖场数智技术应用的影响,对推动畜牧业转型升级、提升农业现代化水平具有重要意义。[方法]文章基于全国15个省区569份规模生猪养殖场调研数据,对我国规模生猪养殖场数智技术应用现状进行了统计分析,并构建似不相关模型分析了动物疫病风险对生猪养殖场数智技术应用的影响。[结果]（1）超过半数的规模养殖场已应用数智技术,其中精准饲喂环节的应用水平最高,环境监测环节的应用水平最低;（2）动物疫病风险会显著促进养殖场在精准饲喂、健康监测、环境监测3个环节应用数智技术,对洗消管理环节的影响不显著;（3）受教育水平、认知水平、养殖规模、生猪品种和产品出口对多个环节的数智技术应用有显著正影响,养殖场年限则有显著负影响。[结论]政府应多措并举,着力提高市场研发适配疫病环境和转型需求的数智技术;制定差异化的生猪养殖场数智技术帮扶政策;构建数智技术应用推广体系,提高养殖者对数智技术的认知水平和转型意愿。