從第三版的Endnote開始用，一下子10多年就過去了，Endnote的進步是非常快速的，可說是一年一版....???
Endnote X4提供了不少新的功能，可惜的是目前不能搭64位元版的Word，只能搭32位元版的Word。
Endnote X4的教育影片可在網站下載，也可以在Youtube上學習。
Enjoy!!!
2010年8月31日 星期二
2010年8月14日 星期六
肝硬化病人術後死亡率的評估
肝硬化病人是否要接受手術，手術後能否存活，是一個必須嚴肅面對的一個問題。
評估病人肝硬化的程度，可用Pugh-Child criteria，目前網路上已有許多簡易的計算機。
Univeristy of Washington Medical Center所提供的計算機：
評估病人肝硬化的程度，可用Pugh-Child criteria，目前網路上已有許多簡易的計算機。
Univeristy of Washington Medical Center所提供的計算機：
Criteria for Child-Pugh Classification
其說明可參見Medical Criteria dot com。
當肝硬化病人接受手術時，在Child B及C的患者，其死亡率極高。
Garrison et al在1984年於Ann Surg發表了肝硬化病人接受腹部手術後死亡的危險因子分析。 其中Table 2最為重要。
Child A: 死亡率 10%。Child B: 死亡率 31%。Child C: 死亡率 76%
Mansour 等人於1997發表於Surgery的結果也是差不多。
Child A: 死亡率 10%。Child B: 死亡率 30%。Child C: 死亡率 82%
腹部手術的死亡率那麼高，那麼肢體的手術呢？
長庚施麗媛等人於J Bone Joint Surg Am報告在肝硬化病人置換全膝人工關節的結果：肝硬化病人平均追蹤42個月後，死亡率15/42 (= 35.7%)，但無人於術後30天內死亡，而所匹配的對照組平均追蹤74個月後死亡率2/42 (= 4.8%)。
長庚謝邦鑫等人於J Bone Joint Surg Br報告在肝硬化病人置換全髖人工關節的結果：術後30天內死亡率 26.7%。
2007年，Mayo Clinic的Teh等人利用Model for End-Stage Liver Disease (MELD)來預測肝硬化病人術後30內死亡的機率，若MELD < 8則為5.7%，若MELD > 20則大於50%。
MELD的網路計算機，Mayo Clinic很慷慨的提供大眾使用：Post-operative Mortality Risk in Patients with Cirrhosis
2010年8月12日 星期四
統計、流病、EBM 10：THE LANCET臨床研究導讀
THE LANCET臨床研究導讀(Handbook of Essential Concepts in Clinical Research)中文版 2008 由Elsevier Taiwan出版，力大圖書經銷。
這是一本好書，但中文版未曾仔細閱讀過，只讀過英文版，Schulz, K. F. 及Grimes, D. A.兩人合著，英國人的英文當然是比較難，但也比較有趣。必需注意的是在第七章關於Youden's J出現錯誤，書中誤植為predictive value positive + predictive value negative - 1，正確為sensitivity + specificity - 1。勘誤表出版於Lancet. 2008 Jun 14;371(9629):1998.。出錯的由來可能來自Armitage, P et al的Statistical Methods in Medical Reseach。
整本書的內容在Lancet 上於2002年及2005年出版。
Introduction
01. An overview of clinical research: the lay of the land.
Observational studies
02. Descriptive studies: what they can and cannot do.
03. Bias and causal associations in observational research.
04. Cohort studies: marching towards outcome.
05. Case-control studies: research in reverse.
06. Compared to what? Finding controls for case-control studies.
Screening tests
07. Uses and abuses of screening tests.
Letter 1: Screening in clinical trials
Letter 2: Screening in clinical trials
Erratum: Lancet. 2008 Jun 14;371(9629):1998
08. Refining clinical diagnosis with likelihood ratios.
Randomised controlled trials
09. Sample size calculations in randomized trials: mandatory and mystical.
10. Generation of allocation sequences in randomized trials: chance, not choice.
11. Allocation concealment in randomized trials: defending against deciphering.
12. Unequal group sizes in randomized trials: guarding against guessing.
13. Sample size slippages in randomized trials: exclusions and the lost and wayward.
14. Blinding in randomized trials: hiding who got what.
15. Multiplicity in randomized trials I: endpoints and treatments.
16. Multiplicity in randomized trials II: subgroup and interim analyses.
這是一本好書，但中文版未曾仔細閱讀過，只讀過英文版，Schulz, K. F. 及Grimes, D. A.兩人合著，英國人的英文當然是比較難，但也比較有趣。必需注意的是在第七章關於Youden's J出現錯誤，書中誤植為predictive value positive + predictive value negative - 1，正確為sensitivity + specificity - 1。勘誤表出版於Lancet. 2008 Jun 14;371(9629):1998.。出錯的由來可能來自Armitage, P et al的Statistical Methods in Medical Reseach。
整本書的內容在Lancet 上於2002年及2005年出版。
Introduction
01. An overview of clinical research: the lay of the land.
Observational studies
02. Descriptive studies: what they can and cannot do.
03. Bias and causal associations in observational research.
04. Cohort studies: marching towards outcome.
05. Case-control studies: research in reverse.
06. Compared to what? Finding controls for case-control studies.
Screening tests
07. Uses and abuses of screening tests.
Letter 1: Screening in clinical trials
Letter 2: Screening in clinical trials
Erratum: Lancet. 2008 Jun 14;371(9629):1998
08. Refining clinical diagnosis with likelihood ratios.
Randomised controlled trials
09. Sample size calculations in randomized trials: mandatory and mystical.
10. Generation of allocation sequences in randomized trials: chance, not choice.
11. Allocation concealment in randomized trials: defending against deciphering.
12. Unequal group sizes in randomized trials: guarding against guessing.
13. Sample size slippages in randomized trials: exclusions and the lost and wayward.
14. Blinding in randomized trials: hiding who got what.
15. Multiplicity in randomized trials I: endpoints and treatments.
16. Multiplicity in randomized trials II: subgroup and interim analyses.
2010年8月9日 星期一
Crowe's Classification
A: head-neck junction至tear drop之參考線之高度
B: Pelvic height
| Group | Description |
| I | Subluxation < 50% or proximal dislocation < 0.1 (10%) of the pelvic height |
| II | Subluxation 50%–75% or proximal dislocation of 0.1 to 0.15 (10% to 15%) of pelvic height |
| III | Subluxation 75%–100% or proximal dislocation of 0.15 to 0.20 (15% to 20%) of pelvic height |
| IV | Subluxation > 100% or proximal dislocation of > 0.20 (20%) of pelvic height |
統計、流病、EBM 9: ABC of Epidemiology
當初在上課時，在同學的介紹之下發現了在 Kidney International 連載的文章 ABC of Epidemiology，也是橫跨三年的文章。他人之石可以攻錯，好文章分享。統計與流病是相輔相成的，正如Sir William Osler所說的"He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all."
01. General and clinical epidemiology at square two: A new educational series for the renal physician.
02. Measuring disease occurrence
03. The randomized clinical trial: An unbeatable standard in clinical research?
04. The valuable contribution of observational studies to nephrology
05. Measures of effect: Relative risks, odds ratios, risk difference, and 'number needed to treat'
06. Bias in clinical research
07. Confounding: What it is and how to deal with it
08. Linear and logistic regression analysis
09. The analysis of survival data: the Kaplan–Meier method
10. The analysis of survival data in nephrology: basic concepts and methods of Cox regression
11. Survival analysis: time-dependent effects and time-varying risk factors
12. The effect of joint exposures: examining the presence of interaction
01. General and clinical epidemiology at square two: A new educational series for the renal physician.
02. Measuring disease occurrence
03. The randomized clinical trial: An unbeatable standard in clinical research?
04. The valuable contribution of observational studies to nephrology
05. Measures of effect: Relative risks, odds ratios, risk difference, and 'number needed to treat'
06. Bias in clinical research
07. Confounding: What it is and how to deal with it
08. Linear and logistic regression analysis
09. The analysis of survival data: the Kaplan–Meier method
10. The analysis of survival data in nephrology: basic concepts and methods of Cox regression
11. Survival analysis: time-dependent effects and time-varying risk factors
12. The effect of joint exposures: examining the presence of interaction
2010年8月3日 星期二
統計、流病、EBM 8：Explorations in Statistics
在 Advances in Physiology Education 連載Douglas Curran-Everett新的統計教學，內容有深有淺，值得仔細探索。特別的是以R為範本，在Supplemental Material中有R的程式碼供使用。
1. Explorations in statistics: standard deviations and standard errors. Adv Physiol Educ 2008;32:203-8.
2. Explorations in statistics: the bootstrap. Adv Physiol Educ 2009;33:286-92.
3. Explorations in statistics: confidence intervals. Adv Physiol Educ 2009;33:87-90.
4. Explorations in statistics: hypothesis tests and P values. Adv Physiol Educ 2009;33:81-6.
5. Explorations in statistics: power. Adv Physiol Educ 2010;34:41-3.
骨科常用的評估工具
Orthopaedic Scores 內有常用的主觀及客觀的各式骨科量表，如Harris Hip Score, Knee Society Score, Tegner Lysholm Knee Scoring System, American Foot and & Ankle Score, Constant Shoulder Score, Mayo Elbow Score, Mayo Wrist Score 等。
統計、流病、EBM 7：Series: Basic statistics for busy clinicians
在Allergologia et Immunopathologia 最近的連載，雖然標示為西班牙文，但實為英文，值得花一點時間看看。
Series: Basic statistics for busy clinicians
01 Sampling and questionnaires. V Perez-Fernandez. Allergol Immunopathol (Madr). 2008;36:228-33.
02 Design and debugging databases for statistical analysis. M M Rodríguez del Águila, P Garrido-Fernández. Allergol Immunopathol (Madr). 2009;37:93-7.
03 Descriptive statistics. S. Pérez-Vicente, M. Expósito Ruiz. Allergol Immunopathol (Madr).2009; 37(06) :314-20.
04 Measures of frequency, magnitude of association and impact in epidemiology. A.R. González-Ramírez, F. Rivas-Ruiz. Allergol Immunopathol (Madr).2010; 38 :147-52.