Consistency analysis of the chief inspection conclusions in physical examination reports / 中华健康管理学杂志

Objective To analyze the consistency of individual examination diagnosis with terminologies expressed in the conclusion report of physical examinations by the chief inspection physician. Methods Based on the clinical classifications used in the Guidelines on Prevention and Treatment of Blood Lipid Abnormality for Chinese Adults, and related terminology descriptions of Dyslipidemias that were actually used in four-item blood lipid examinations diagnosis, a lexicon database of Hyperlipidemias was constructed with 39 terms used in the four-item blood lipid examination diagnosis and chief physician conclusions. Totally 11953 electronic chief physician inspection reports from 8 health check-up institutions were included. We investigated the terms of lexicon database using word frequency analysis method, calculated the positive rate in the diagnosis of four single examinations of serum lipid and the positive rate in the chief physician's conclusion. Consistency of chief physician's conclusion with single examination diagnosis was analyzed by Kappa test. Results (1) Among the 39 terms of lexicon database, there are 18 nonstandard terms used in single examination diagnosis, accounted for 46％ of all terms; (2) In word frequency analysis, there are only 1％ of terms that corresponded to clinical classifications of Hyperlipidemias accurately;(3) The positive rate of Hyperlipidemias in serum lipid four single examinations diagnosis was 47％, the positive rate of physician diagnosis was 35％. The consistency analysis of chief physician conclusions with single examination diagnosis showed Kappa=0.71(P0.75 may be suggested as a favorable value.

Mortality and burden of non-communicable diseases in China / 中华健康管理学杂志

Objective To assess the leading causes of death and disability adjusted life year (DALY) due to non-communicable disease (NCD) in China.Methods World Health Report 2004 published by the World Health Organization (WHO) was reviewed,including total deaths,deaths per 100 000,agestandardized death rate per 100 000,total DALYs,DALYs per 100 000 and age-standardized DALYs per 100 000 by cause and by member state.Diseases or injuries were assigned to three levels:communicable diseases,NCD and injuries (the first level); categories of disease or injure (the second level); specific diseases (the third level).R2.15 was used for data analysis.Results NCD causes 737.6 million deaths,141million total DALY years,627 age standardized mortality per 100 000,and 10 829 age-standardized DALYs per 100 000.NCD account for 79.4％ and 70.3％ total death or all-cause DALYs.Conclusions Cardiovascular disease,malignant neoplasm and respiratory disease were the leading causes of death,while neuropsychiatric disorder,cardiovascular disease and sense organ disease were the most important causes of DALYs.Among China,the United Kingdom,the United States,Canada,Japan,Korea and India,China ranked second in age-standardized mortality rate of chronic disease.DALYs of esophagus cancer and chronic obstructive pulmonary disease were 6 or 2 times of world average level.Besides,the increasing trend in the prevalence of diabetes mellitus remains impressive.

Investigation of Data Representation Issues in Computerizing Clinical Practice Guidelines in China / 대한의료정보학회지

OBJECTIVES: From the point of view of clinical data representation, this study attempted to identify obstacles in translating clinical narrative guidelines into computer interpretable format and integrating the guidelines with data in Electronic Health Records in China. METHODS: Based on SAGE and K4CARE formulism, a Chinese clinical practice guideline for hypertension was modeled in Protege by building an ontology that had three components: flowchart, node, and vMR. Meanwhile, data items imperative in Electronic Health Records for patients with hypertension were reviewed and compared with those from the ontology so as to identify conflicts and gaps between. RESULTS: A set of flowcharts was built. A flowchart comprises three kinds of node: State, Decision, and Act, each has a set of attributes, including data input/output that exports data items, which then were specified following ClinicalStatement of HL7 vMR. A total of 140 data items were extracted from the ontology. In modeling the guideline, some narratives were found too inexplicit to formulate, and encoding data was quite difficult. Additionally, it was found in the healthcare records that there were 8 data items left out, and 10 data items defined differently compared to the extracted data items. CONCLUSIONS: The obstacles in modeling a clinical guideline and integrating with data in Electronic Health Records include narrative ambiguity of the guideline, gaps and inconsistencies in representing some data items between the guideline and the patient' records, and unavailability of a unified medical coding system. Therefore, collaborations among various participants in developing guidelines and Electronic Health Record specifications is needed in China.

Fatty liver disease index: a simple screening tool to facilitate diagnosis of nonalcoholic fatty liver disease in the Chinese population.

BACKGROUND AND OBJECTIVES: A simple screening tool is needed as an aid to optimize management of nonalcoholic fatty liver disease (NAFLD). The purpose of this study was to design a simple index that could be used to predict the presence of NAFLD. METHODS: A cross-sectional case-control study design was used for this study with 6,926 subjects who had received health assessments. RESULTS: Multivariate analysis indicated that body mass index (BMI), triglyceride (TG), alanine aminotransferase (ALT) to aspartate aminotransferase (AST) ratio (ALT/AST ratio), and hyperglycemia (HG) were independent risk factors for NAFLD. These variables were used to construct a fatty liver disease (FLD) index: FLD index = BMI + TG + 3 × (ALT/AST ratio) + 2 × HG (presence of HG, HG = 1; absence of HG, HG = 0). The FLD index had an area under the receiver-operating characteristic (AUROC) curve of 0.819 in the training set and 0.817 in the validation set. Values of the FLD index <28.0 or >37.0 excluded the possibility of NAFLD with sensitivity of 94.9 % or detected NAFLD with specificity of 96.0 %, respectively. CONCLUSIONS: The FLD index is a simple, efficient NAFLD screening tool for the Chinese population that may be used to select people for further analysis and/or treatment, and/or for lifestyle modification.

A conceptual framework for synopsis of information of health examination reports and its style sheet / 中华健康管理学杂志

Objective To develop a conceptual framework for the synopsis of information of health examination reports (HERs) and its style sheet so as to provide a reference for information collection and management in health examination institutions.Methods A conceptual framework for the synopsis of information of HERs and its core data elements were developed based on HERs items from 11 health examination institutions,and a style sheet for the synopsis of information of HERs was then designed.Results The conceptual framework included 4 dimensions (e.g.identification information,health-related information,health exam summary,health evaluation and guidance),16 sub-dimensions,52 core data elements and 25 value domains.The structure and content of the designed sheet were consistent with the dimensions,subdimensions and core data elements of the conceptual framework.Conclusions The developed synopsis of information of HERs could be a feasible solution for structured and standardized representation of clients' health examination information.The selection and filling of some items should be validated and refined in the future.

Conceptual framework and core data elements of health lifestyle questionnaire / 中华健康管理学杂志

Objective To construct a conceptual framework of a lifestyle questionnaire and define its dimensions,sub-dimensions and core data elements.Methods After review of lifestyle questionnaires of large-scale studies,domestic and international health information standards,health risk factors defined by the World Health Organization and paper-based health records,a conceptual framework was developed by using top-down and bottom-up strategies.Core data elements were chosen according to their importance,utility and experts' advice.Results Our conceptual framework included 9 dimensions (cigarette smoking,alcohol consumption,diet,water drinking,employment,physical exercises,daily living habits,sleep and toxic exposure) and 29 sub-dimensions.For instance,cigarette smoking included status,intensity,duration of smoking and kinds of tobacco.Furthermore,24 core data elements were extracted,and coded values were defined for parts of these data elements.Conclusions Our conceptual framework may serve as a reference for the development of lifestyle questionnaire,and the standardized data elements we extracted could be used in information exchang between institutions.However,standardization of the data elements should be further refined.

Development of overall health risk model and its convergent validity and reliability assessment / 中华健康管理学杂志

Objective To develop an overall health risk model and to evaluate its convergent validity and reliability.Methods Health examination results of 230 adults from a public institution were collected by using Chinese Health Risk Appraisal Questionnaire V1.0 (CHRAQ V1.0).An CHRAQ V1.0-based overall health risk model was then developed,which included 34 items.Kolmogorov-Smirnov was used to test normal distribution of the data.Pearson correlation coefficient and Spearman correlation coefficient were used to evaluate parallel validity of the model.Crane Bach coefficient,Spearman-Brown coefficient and test-retest reliability were calculated to evaluated the reliability of the model.Results In this study,212 valid questionnaires (92.17％) were received.The average score of the newly developed overall health risk model was 41.96 ± 9.69,and its kurtosis coefficient and coefficient of skewness were 2.105 and 0.862,respectively.In Kolmogorov-Smirnov,the data were normally distributed (Z =1.073,P =0.199).The correlation coefficient of positive rate of all objective examinations with model scores was 0.774 (P ＜ 0.05).The Cronbach's alpha coefficient,Spearman-Brown coefficient and test-retest reliability of the model were 0.652,0.784 and 0.841,respectively (P ＜ 0.05).Conclusion In this investigation,our newly developed overall health risk model shows good validity and reliability and application prospect in the field of health management.

Prevalence and risk factors for depression in older people in Xi'an China: a community-based study.

OBJECTIVE: To estimate the prevalence of depressive symptoms and to determine the impact of socio-demographic variables, chronic diseases and health-related events on depression in a community sample of older adults in Xi'an, Shaanxi Province. METHODS: Cross sectional, multistage community survey. A semi-structured questionnaire including socio-demographic characteristics, physical health, chronic diseases and health-related events was administered to 1587 older adults from eight communities. Depression was assessed using the 30-item Geriatric Depression Scale (GDS) with a threshold of <11/11+. Analysis was conducted using SPSS16.0 Complex Samples Logistic analysis procedure. RESULTS: The prevalence of depression was 27.0% (95% CI 24.7-29.2%). In a univariate analysis, the following variables were significantly associated with depression: female gender, low max income, coronary heart disease, suffering 3 or above chronic diseases and functional impairments, 4 adverse life events (financial problems, death of closely related person, unpleasantness experience and horrifying experience) and suffering 1 or above adverse life events. After adjustment for age and gender, odds ratios for depression were significantly higher for coronary heart disease, suffering 3 or above chronic diseases and functional impairments, adverse life event (financial problems, unpleasantness experience) and suffering 3 or above adverse life events. CONCLUSIONS: According to GDS estimates, 27.0% Chinese urban older adult had depression symptoms. In designing prevention programs, detection and management of older patients with depression should be a high priority in developing countries.

The Development of Clinical Document Standards for Semantic Interoperability in China / 대한의료정보학회지

OBJECTIVES: This study is aimed at developing a set of data groups (DGs) to be employed as reusable building blocks for the construction of the eight most common clinical documents used in China's general hospitals in order to achieve their structural and semantic standardization. METHODS: The Diagnostics knowledge framework, the related approaches taken from the Health Level Seven (HL7), the Integrating the Healthcare Enterprise (IHE), and the Healthcare Information Technology Standards Panel (HITSP) and 1,487 original clinical records were considered together to form the DG architecture and data sets. The internal structure, content, and semantics of each DG were then defined by mapping each DG data set to a corresponding Clinical Document Architecture data element and matching each DG data set to the metadata in the Chinese National Health Data Dictionary. By using the DGs as reusable building blocks, standardized structures and semantics regarding the clinical documents for semantic interoperability were able to be constructed. RESULTS: Altogether, 5 header DGs, 48 section DGs, and 17 entry DGs were developed. Several issues regarding the DGs, including their internal structure, identifiers, data set names, definitions, length and format, data types, and value sets, were further defined. Standardized structures and semantics regarding the eight clinical documents were structured by the DGs. CONCLUSIONS: This approach of constructing clinical document standards using DGs is a feasible standard-driven solution useful in preparing documents possessing semantic interoperability among the disparate information systems in China. These standards need to be validated and refined through further study.

Classification and Coding of Medical Science Data / 中国康复理论与实践

@#ObjectiveTo develop the classification and coding of medical science data so as to merge and manage the data effectively.MethodsClassification frame was developed with linear classification, coding with matching design.ResultsThe medical science data classification frame, the contents of the frame and their code have been developed. ConclusionThe development of the classification and coding can merge and organize the medical science data effectively.

Metadata Study in Medical Data Resource Share / 中国康复理论与实践

@#ObjectiveTo study the application of Metadata in search and find data with different structue in medical data resources share.MethodsStudy the definition and character of metadata, establish the metadata standard and directory service system to execute the data search service.ResultsThe Directory Service System based on the method of metadata has been developed, in which the data search service can be realized. ConclusionThe Directory Service System based on the method of metadata has been developed, in which the data search service can be realized. Conclusions It's a effective way to search and find data with different structue using method of metadata, and it is a important way to realize medical data resource share.

Study on the Distribution of Hypertension in Recruited Chinese Male Youth through Spatial Local Interpolation Technique / 中国慢性病预防与控制

Objective To explore the spatial distribution of hypertension in recruited Chinese male youth.Methods Maps of spatial distribution on hypertension detection rates in recruited Chinese male youth were produced,using a spatial local interpolation technique with the ArcGIS8.1 software.Cross-validation techniques were used to evaluate the fitness of the distribution maps.Results The spatial distribution of hypertension detection rates in recruited Chinese male youth in 2001 showed that the detectable rate of the hypertension of the recruited male youth was distributed in sections.The sections with a higher rate included Hebei,Shandong and Beijing,as the center of the northern area,and Guangxi,as the center of the southern area.The detectable rate of diastolic pressure was found higher in the areas of northeast and north China than in other places.The prediction error of the cross-validation indicated that the spatial distribution maps of hypertension detecting rates had good fitness to hypertension detecting rates of recruited Chinese male youth.Conclusion There existed in significant spatial difference in hypertension detecting rates of recruited Chinese male youth.Influence of geographical environment,climate,and economy on adolescents' blood pressure should be further studied.

Converting rules from international classification of disease codes of trauma to abbreviated injury scale values / 中华创伤杂志

Objective To develop converting rule from international classification of disease (ICD) codes of trauma to abbreviated injury scale (AIS) values so as to provide clues for a simple and convenient trauma scoring way. Methods The corresponding set relations were made for ICD-9CM codes and AIS-90 codes with similar code meanings in the trauma diseases. Based on medical theories and knowledge, 8 indeces closely associated with injury severity were worked out for each ICD-9CM code of trauma diseases by using the database of discharge abstracts of trauma patients. Discriminant analysis was used to set up corresponding relations of ICD-9CM codes with AIS values. Results Seven indices were selected for discriminant function. Corresponding relations of all ICD-9CM codes of trauma diseases with AIS values was made through nonparametric discriminant method. Under deliberation and revision by several clinical experts on traumatology, the converting rule was established eventually. Consistency analysis between the sample's international classification of disease injury severity score (ICISS) values and injury severity score (ISS) values showed that ICISS values were closely correlated with 2-ICISS (Y=Ln), with correlation coefficient of 0.831 1 ( P

Synopsis of studies on case mix plans in China / 中华医院管理杂志

Objective To formulate genuine case mix plans using medical record information available in China. Methods An account was given of the research background of case mix studies, the current status of the studies and applications at home and abroad, the case mix model for measuring medical "output", data sources and statistical methods of classification. Results Case mix plans for army inpatients, civilian inpatients and outpatients were respectively formulated, and software for calculating the case mix index of a hospital which can run on Windows 95/98 computer systems was developed. Conclusion The theoretical, methodological and data conditions necessary for the formulation of case mix plans based on the first pages of medical records in China are now ripe and the case mix plans formulated on the basis of data from large samples can now be used for the control of medical costs, the assessment of a hospital's medical "output" and the estimation of the financial compensations for hospitals.

Accurate Measurement of Automated Sphygmomanometer / 医疗卫生装备

Objective To show the international protocols for blood pressure monitoring based on a real example. Methods The assessment process of international protocol that can be released by Working Group on Blood Pressure Monitoring of European Society of Hypertension was evaluated. Results 33 participants were selected, which all indexes in evaluation stage one and stage two of the indicators were detected through. The 95% consistency interval in difference between tested device and reference monitor was 10.65～-12.67 mmHg for systolic BP and 13.68～-14.03 mmHg for diastolic BP, and there were 7.1% (7/99) and 6.1% (6/99) of valid points out of the 95% consistency interval. Conclusion The measured automatic blood pressure in the normal environment, measuring accuracy and the standard with the control of mercury -type sphygmomanometer is coincident, so it can be recommended for home application.

A new comprehensive trauma score method based on international classification of diseases and the effectiveness of its use in cerebral injured patients / 中华创伤杂志

Objective To develop a new comprehensive trauma score method based on international classification of diseases(ICD) and evaluate the effectiveness of its use in cerebral injured patients.Methods The model of the new trauma score method was constructed by referring to those of some certain comprehensive trauma score methods generally used around the world.Receiver operating characteristics(ROC) analysis was employed to evaluate the effectiveness of outcome prediction for 355 cerebral injured patients using the new developed trauma score method.Statistical comparisons were performed between the AUC for the new trauma score values and that of NISS values derived from two professional raters.Results The area under the curve(AUC) for the new trauma score values was as large as 0.925 4,whose 95% CI ranged from 0.863 4 to 0.987 5,and is statistically different from 0.5(P

The application of data warehouse to the usage of medical quality information / 医疗卫生装备

Objective To set up the medical quality information statistics resource database of No.1 Military Medical Project by data warehouse technology. Method The front-end display tool of OLAP is applied to the setup of the database. Result OLAP platform is established and convenient query, statistics can be realized. Conclusion A great deal of aid decision making information can be got. Thus, the hospital resource utilization and medical quality management are improved.

Data mining and utilization of operation information sources of HIS / 医疗卫生装备

Operation information is the important component of HIS sources. Data mining software Brioquery can be used to extract qualitative and quantitive information related to the operation from HIS system. With the ever-growing demand of hospital management for information service, people's ability to collect and compile data by means of information technology will be greatly increased to make the best of information for medical management.

Consistency Evaluation Method in Accurate Measurement of Automated Sphygmomanometer / 医疗卫生装备

Objective To compare blood pressures results measured by automated sphygmomanometer and standard mercury sphygmomanometer,and to investigate the application of measurements consistency evaluation method in accurate measurement of automated sphygmomanometer.Methods Intraclass correlation coefficient was used to estimate the reliability of repeated measurements,and Bland -Altman method was adopted to evaluate the consistency between automated sphygmomanometer and standard mercury sphygmomanometer.Meanwhile,the results were compared with protocol of European Society of Hypertension.Results The tested automated sphygmomanometer did not adapt to the criteria of European Society of Hypertension.The intraclass correlation coefficient of mercury sphygmomanometer was 0.937 for systolic blood pressure,0.849 for diastolic blood pressure.The intraclass correlation coefficient of tested sphygmomanometer was 0.944 for systolic blood pressure,0.929 for diastolic blood pressure.The 95% consistency interval was(-10.20 to 16.94)mmHg for systolic blood pressure and(-6.25 to 11.69)mmHg for diastolic blood pressure.Conclusion Normally,Bland-Altman method has the same judgment result with protocol of European Society of Hypertension.

THE PHYSIQUE STATUS AND ITS CHRONOLOGICAL CHANGES IN RECRUITED YOUTHS IN CHINA / 解放军医学杂志

This study was aimed to obtain a general knowledge of physical status and its chronological changes in young Chinese recruits. 73 000 physical examination data of young male recruits were collected in 100 sample units selected by the method of cluster sampling from 31 provinces in China. Height, weight, chest circumference, and body mass index(BMI) were analyzed. The results showed that the recruits from Northeast China and North China were the tallest (170 3cm and 170 6cm on average), the heaviest (60 4kg and 61 6kg), their chest circumference largest(83 4cm and 84 6cm), and their BMI were the largest(20 8 and 21 5kg/m 2). Comparing with historical data, the average height increased 6 6cm since 1955 and 4 1cm since 1974. The body weight increased 5 6kg since 1955 and 3 5kg since 1974. Chest circumference increased slightly, the mean values of which in the three periods were 20 3, 20 1 and 19 8kg/m 2, respectively. The recruits from southwertern and south China showed least growth, and their BMI was virtually lower than before. The results of this survey indicated that a significant difference in the physical status among youth recruits from different areas in China. Lack of growth of chest circumference and BMI in youths from some areas should arouse our attention