BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: OBJECTIVE:This study evaluated whether serious bacterial infections are more frequent at family practices with lower antibiotic prescribing rates. DESIGN:Cohort study. SETTING:706 UK family practices in the Clinical Practice Research Datalink from 2002 to 2017. PARTICIPANTS:10.1 million registered patients with 69.3 million patient-years' follow-up. EXPOSURES:All antibiotic prescriptions, subgroups of acute and repeat antibiotic prescriptions, and proportion of antibiotic prescriptions associated with specific-coded indications. MAIN OUTCOME MEASURES:First episodes of serious bacterial infections. Poisson models were fitted adjusting for age group, gender, comorbidity, deprivation, region and calendar year, with random intercepts representing family practice-specific estimates. RESULTS:The age-standardised antibiotic prescribing rate per 1000 patient-years increased from 2002 (male 423; female 621) to 2012 (male 530; female 842) before declining to 2017 (male 449; female 753). The median family practice had an antibiotic prescribing rate of 648 per 1000 patient-years with 95% range for different practices of 430-1038 antibiotic prescriptions per 1000 patient-years. Specific coded indications were recorded for 58% of antibiotic prescriptions at the median family practice, the 95% range at different family practices was from 10% to 75%. There were 139 759 first episodes of serious bacterial infection. After adjusting for covariates and the proportion of coded consultations, there was no evidence that serious bacterial infections were lower at family practices with higher total antibiotic prescribing. The adjusted rate ratio for 20% higher total antibiotic prescribing was 1.03, (95% CI 1.00 to 1.06, p=0.074). CONCLUSIONS:We did not find population-level evidence that family practices with lower total antibiotic prescribing might have more frequent occurrence of serious bacterial infections overall. Improving the recording of infection episodes has potential to inform better antimicrobial stewardship in primary care.

背景与目标：

BACKGROUND & AIMS: :The main goal of this study was to reconstruct the Late Pleistocene-Holocene floristic composition in an area of the northern Brazilian Amazonia, comparing the results with other Amazonian localities in order to discuss the factors that have influenced phytophysiognomic changes over this time period. The work in eastern Marajó Island at the mouth of the Amazonas River was approached based on analysis of 98 pollen and diatom samples from core data distributed along a proximal to distal transect of a paleoestuarine system. The results indicated high concentration of Rhizophora, associated with arboreal pollen grains typical of the modern Amazonian rainforest during the last 40,000 cal yrs BP. Pollen composition also included wetland herbs. Diatoms were dominated by marine and fresh water taxa. Wetland forest, mangrove and, subordinately herbs remained constant during most of the latest Pleistocene-early/middle Holocene. At 5,000 cal yrs BP, there was a distinguished change from forest and mangrove to wet grassland savanna due to sea level fluctuation. As marine influence decreased, the estuary gave rise to fresh water lacustrine and swamp environments, with establishment of herbaceous campos. A main conclusion from this study is that solely the occurrence of herbaceous savanna can not be used as a definitive indicator of past dry climates in Amazonian areas.

背景与目标： : 这项研究的主要目的是重建巴西北部亚马逊地区的晚更新世-全新世植物区系，并将结果与其他亚马逊地区进行比较，以讨论在此期间影响植物生理学变化的因素。根据沿古河口系统的近端到远端横断面分布的核心数据对98个花粉和硅藻样本进行的分析，对亚马逊河河口的东部maraj ó 岛的工作进行了研究。结果表明，在过去的40,000年BP中，根瘤菌的浓度很高，与现代亚马逊雨林中典型的树栖花粉粒有关。花粉成分还包括湿地草药。硅藻以海洋和淡水分类群为主。在最新的更新世-早/中全新世的大部分时间里，湿地森林，红树林和次生草药保持不变。在BP 5,000年，由于海平面波动，从森林和红树林到湿草原稀树草原发生了显着变化。随着海洋影响的减少，河口形成了淡水湖相和沼泽环境，并建立了草本campos。这项研究的主要结论是，仅草本稀树草原的发生不能用作亚马逊地区过去干旱气候的确切指标。

BACKGROUND & AIMS: :The 2009 American Recovery and Reinvestment Act spurred adoption of electronic health records (EHRs) in the United States, through such measures as financial incentives to providers through Medicare and Medicaid and regional extension centers, which provide ongoing technical assistance to practices. Yet the relationship between EHR adoption and quality of care remains poorly understood. We evaluated the early effects on quality of the Primary Care Information Project, which provides subsidized EHRs and technical assistance to primary care practices in underserved neighborhoods in New York City, using the regional extension center model. We found that just general participation in, or exposure to, the project was not enough to improve quality of care. It took sustained exposure on the part of these practices and technical assistance to them before they demonstrated improvement on measures of care most likely to be affected by the use of electronic health records, such as cancer screenings and care for patients with diabetes. Participating in the Primary Care Information Project for nine or more months was associated with significantly improved quality, but only for this limited group of quality measures and only for physicians receiving extensive technical assistance.

背景与目标： : 2009的《美国复苏和再投资法案》 (American Recovery and Reinvestment Act) 通过诸如通过Medicare和Medicaid以及区域扩展中心向提供者提供财务激励等措施，刺激了电子健康记录 (ehr) 在美国的采用，这些措施为实践提供持续的技术援助。然而，EHR采用与护理质量之间的关系仍然知之甚少。我们评估了初级保健信息项目对质量的早期影响，该项目使用区域扩展中心模型为纽约市服务不足的社区的初级保健实践提供补贴的ehr和技术援助。我们发现，仅仅参与或接触该项目不足以提高护理质量。这些做法和技术援助需要持续暴露，然后才证明最有可能受到电子健康记录使用影响的护理措施有所改善，例如癌症筛查和糖尿病患者护理。参与初级保健信息项目9个月或更长时间与质量显着提高有关，但仅适用于这一有限的质量措施组，并且仅适用于接受广泛技术援助的医生。

BACKGROUND & AIMS: OBJECTIVE:Clinician narrative style in electronic health records (EHR) has rarely been investigated. Clinicians sometimes record brief quotations from patients, possibly more frequently when higher risk is perceived. We investigated whether the frequency of quoted phrases in an EHR was higher in time periods closer to a suicide attempt. DESIGN:A case-crossover study was conducted in a large mental health records database. A natural language processing tool was developed using regular expression matching to identify text occurring within quotation marks in the EHR. SETTING:Electronic records from a large mental healthcare provider serving a geographic catchment of 1.3 million residents in South London were linked with hospitalisation data. PARTICIPANTS:1503 individuals were identified as having a hospitalised suicide attempt from 1 April 2006 to 31 March 2017 with at least one document in both the case period (1-30 days prior to admission) and the control period (61-90 days prior to admission). OUTCOME MEASURES:The number of quoted phrases in the control as compared with the case period. RESULTS:Both attended (OR 1.05, 95% CI 1.02 to 1.08) and non-attended (OR 1.15, 95% CI 1.04 to 1.26) clinical appointments were independently higher in the case compared with control period, while there was no difference in mental healthcare hospitalisation (OR 0.99, 95% CI 0.98 to 1.01). In addition, there was no difference in the levels of quoted text between the comparison time periods (OR 1.09, 95% CI 0.91 to 1.30). CONCLUSIONS:This study successfully developed an algorithm to identify quoted speech in text fields from routine mental healthcare records. Contrary to the hypothesis, no association between this exposure and proximity to a suicide attempt was found; however, further evaluation is warranted on the way in which clinician-perceived risk might be feasibly characterised from clinical text.

背景与目标：

BACKGROUND & AIMS: :The Electronic Medical Records and Genomics Network is a National Human Genome Research Institute-funded consortium engaged in the development of methods and best practices for using the electronic medical record as a tool for genomic research. Now in its sixth year and second funding cycle, and comprising nine research groups and a coordinating center, the network has played a major role in validating the concept that clinical data derived from electronic medical records can be used successfully for genomic research. Current work is advancing knowledge in multiple disciplines at the intersection of genomics and health-care informatics, particularly for electronic phenotyping, genome-wide association studies, genomic medicine implementation, and the ethical and regulatory issues associated with genomics research and returning results to study participants. Here, we describe the evolution, accomplishments, opportunities, and challenges of the network from its inception as a five-group consortium focused on genotype-phenotype associations for genomic discovery to its current form as a nine-group consortium pivoting toward the implementation of genomic medicine.

背景与目标： : 电子病历和基因组学网络是由国家人类基因组研究所资助的财团，致力于开发使用电子病历作为基因组研究工具的方法和最佳实践。现在已经进入第六年和第二个资助周期，由九个研究小组和一个协调中心组成，该网络在验证从电子病历中得出的临床数据可以成功用于基因组研究的概念方面发挥了重要作用。当前的工作是在基因组学和医疗保健信息学的交叉点上提高多个学科的知识，尤其是电子表型，全基因组关联研究，基因组医学实施以及与基因组学研究相关的伦理和监管问题，并将结果返回给研究参与者。在这里，我们描述了网络的发展，成就，机遇和挑战，从其成立为五组联盟，专注于基因组发现的基因型-表型关联，到目前的形式为九组联盟，转向实施基因组医学。

BACKGROUND & AIMS: BACKGROUND:Routine weight recording in electronic health records (EHRs) could assist general practitioners (GPs) in the identification, prevention, and management of overweight patients. However, the extent to which weight management is embedded in general practice in the Netherlands has not been investigated. The purpose of this study was to evaluate the frequency of weight recording in general practice in the Netherlands for patients who self-reported as being overweight. The specific objectives of this study were to assess whether weight recording varied according to patient characteristics, and to determine the frequency of weight recording over time for patients with and without a chronic condition related to being overweight. METHODS:Baseline data from the Occupational and Environmental Health Cohort Study (2012) were combined with data from EHRs of general practices (2012-2015). Data concerned 3446 self-reported overweight patients who visited their GP in 2012, and 1516 patients who visited their GP every year between 2012 and 2015. Logistic multilevel regression analyses were performed to identify associations between patient characteristics and weight recording. RESULTS:In 2012, weight was recorded in the EHRs of a quarter of patients who self-reported as being overweight. Greater age, lower education level, higher self-reported body mass index, and the presence of diabetes mellitus, chronic obstructive pulmonary disease, and/or cardiovascular disorders were associated with higher rates of weight recording. The strongest association was found for diabetes mellitus (adjusted OR = 10.3; 95% CI [7.3, 14.5]). Between 2012 and 2015, 90% of patients with diabetes mellitus had at least one weight measurement recorded in their EHR. In the group of patients without a chronic condition related to being overweight, this percentage was 33%. CONCLUSIONS:Weight was frequently recorded for overweight patients with a chronic condition, for whom regular weight measurement is recommended in clinical guidelines, and for which weight recording is a performance indicator as part of the payment system. For younger patients and those without a chronic condition related to being overweight, weight was less frequently recorded. For these patients, routine recording of weight in EHRs deserves more attention, with the aim to support early recognition and treatment of overweight.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Hypersensitivity reactions (HSRs) are immunologic responses to drugs. Identification of HSRs documented in the electronic health record (EHR) is important for patient safety. OBJECTIVE:To examine HSR epidemiology using longitudinal EHR data from a large United States health care system. METHODS:Patient demographic information and drug allergy data were obtained from the Partners Enterprise-wide Allergy Repository for 2 large tertiary care hospitals from 2000 to 2013. Drug-induced HSRs were categorized into immediate and delayed HSRs based on typical phenotypes. Causative drugs and drug groups were assessed. The prevalence of HSRs was determined, and sex and racial differences were analyzed. RESULTS:Among 2.7 million patients, 377,474 (13.8%) reported drug-induced HSRs, of whom 70.3% were female and 77.5% were white. A total of 580,456 HSRs were reported, of which 53.1% were immediate reaction phenotypes. Common immediate HSRs included hives (48.8%), itching (15.0%), and angioedema (14.1%). Delayed HSR phenotypes (46.9%) were largely rash (99.0%). Penicillins were associated with the most immediate (33.0%) and delayed (39.0%) HSRs. Although most HSRs were more prevalent in females and white patients, notable differences were identified for certain rare HSRs including acute interstitial nephritis, which appeared more commonly in males (0.02% vs 0.01%, P < .001). Asian patients had more fixed drug eruptions (0.007% vs 0.002%, P = .021) and severe cutaneous adverse reactions (0.05% vs 0.04%, P < .001). CONCLUSIONS:Drug HSRs were reported in 13.8% of patients. Almost one-half of reported immediate HSR phenotypes were hives, and almost all reported delayed HSR phenotypes were rash. HSRs largely affected female and white patients, but differences were identified for specific rare HSRs.

背景与目标：

BACKGROUND & AIMS: :The sediment concentrations of total petroleum hydrocarbons (TPHs), polyaromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), Pb and (207/206)Pb isotope ratios were measured in seven cores from the middle Clyde estuary (Scotland, UK) with an aim of tracking the late Anthropocene. Concentrations of TPHs ranged from 34 to 4386 mg kg(-1), total PAHs from 19 to 16,163 μg kg(-1) and total PCBs between less than 4.3 to 1217 μg kg(-1). Inventories, distributions and isomeric ratios of the organic pollutants were used to reconstruct pollutant histories. Pre-Industrial Revolution and modern non-polluted sediments were characterized by low TPH and PAH values as well as high relative abundance of biogenic-sourced phenanthrene and naphthalene. The increasing industrialization of the Clyde gave rise to elevated PAH concentrations and PAH isomeric ratios characteristic of both grass/wood/coal and petroleum and combustion (specifically petroleum combustion). Overall, PAHs had the longest history of any of the organic contaminants. Increasing TPH concentrations and a concomitant decline in PAHs mirrored the lessening of coal use and increasing reliance on petroleum fuels from about the 1950s. Thereafter, declining hydrocarbon pollution was followed by the onset (1950s), peak (1965-1977) and decline (post-1980s) in total PCB concentrations. Lead concentrations ranged from 6 to 631 mg kg(-1), while (207/206)Pb isotope ratios spanned 0.838-0.876, indicative of various proportions of 'background', British ore/coal and Broken Hill type petrol/industrial lead. A chronology was established using published Pb isotope data for aerosol-derived Pb and applied to the cores.

背景与目标： : 在克莱德河口中部 (英国苏格兰) 的七个岩心中测量了总石油烃 (TPHs)，多环芳烃 (PAHs)，多氯联苯 (PCBs)，Pb和 (207/206)Pb同位素比的沉积物浓度。追踪晚期人类世。TPHs的浓度范围为34至4386 mg kg(-1)，总PAHs的浓度范围为19至16,163 μ g kg(-1)，总pcb的浓度范围为小于4.3至1217 μ g kg(-1)。有机污染物的清单，分布和异构体比率用于重建污染物历史。工业革命前和现代无污染沉积物的特征是TPH和PAH值低，生物来源的菲和萘的相对丰度高。克莱德 (Clyde) 日益工业化，导致草/木/煤和石油与燃烧 (特别是石油燃烧) 的PAH浓度和PAH异构体比率升高。总体而言，PAHs在任何有机污染物中都有最长的历史。TPH浓度的增加和PAHs的下降反映了大约20世纪50年代以来煤炭使用量的减少和对石油燃料的依赖增加。此后，碳氢化合物污染下降之后是总PCB浓度的开始 (20世纪50年代)，峰值 (1965-1977) 和下降 (post-1980s)。铅的浓度范围为6至631 mg kg(-1)，而 (207/206)Pb同位素比跨越0.838-0.876，这表明 “背景”，英国矿石/煤炭和破山型汽油/工业铅的各种比例。使用已发布的气溶胶衍生Pb的Pb同位素数据建立了年表，并将其应用于岩心。

BACKGROUND & AIMS: OBJECTIVE:To determine how patients and physicians balance the perceived benefits and harms of sharing electronic health data for patient care and for secondary purposes. DESIGN:Before-after survey of patients and providers in practices using electronic medical records (EMRs) enrolled in a clinical trial in Ontario, Canada. MEASUREMENTS:Outcomes were measured using the Health Information Privacy Questionnaire (HIPQ) at baseline and end of study. Thirteen questions in 4 general domains investigated attitudes towards the privacy of EMRs, outsider's use of patient's health information, the sharing of patient's information within the health care system, and the overall perception of benefits versus harms of computerization in health care. RESULTS:511 patients (mean age 60.3 years, 49.6% female) and 46 physicians (mean age 47.2 years, 37.0% female) participated. Most (>90%) supported the computerized sharing of the patient's health records among their health care professionals and to provide clinical advice. Fewer agreed that the patient's de-identified information should be shared outside of the health care circle (<70%). Only a minority of either group supported the notion that computerized records can be keep more private than paper records (38-50%). Overall, a majority (58% patients, 70% physicians) believed that the benefits of computerization were greater than the risks of confidentiality loss. This was especially true for patients who were frequent computer users. DISCUSSION:While these primary care physicians and their patients valued the clinical features of EMRs, a substantial minority have concerns about the secondary use of de-identified information.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:With the implementation of Chinese economic reform and rapid urbanization, policies and values surrounding migration have changed and given rise to unprecedented population mobility. This study is designed to examine the effect of Hukou origin on establishment of health records among internal migrants in China. METHODS:The data used for this study are from the 2015 National Internal Migrant Population Dynamic Monitoring Survey, covering 112,782 migrants nationwide. For continuous variables, the p value is calculated using Student t test; for categorical variables, the p value is calculated using chi-square test. Binary logistic regression with an enter method is employed to assess the association of establishment of health records with origin residence. RESULTS:About 35.1% of the migrant population has established health records in their inflow communities, with 37.4% established among those of urban origin and 34.8% established among those of rural origin. The establishment of health records is significantly higher among migrants of urban origin than among migrants of rural origin (OR = 1.057; 1.017-1.098). Our results also show that among populations of both rural and urban origin, inter-province migrants, along with migrants who are employers, have no plans for long-term residence, have no insurance, and have more family income less likely to establish health records. CONCLUSIONS:This study demonstrates that residence is associated with establishment of health records among the migrant population in China. Targeted policies should be made to improve the establishment of health records among migrants of both rural and urban origins.

背景与目标：

BACKGROUND & AIMS: :Source document verification (SDV) is a basic and vital part of monitoring activities in clinical trials. In most cases, SDV involves the examination of medical records by a third party or an individual who is not an employee of the health care institution responsible for medical records storage and maintenance. It is therefore vital for health care institutions to ensure that their third-party access policies are compliant with applicable guidelines, laws, and regulations. A quantitative cross-sectional study design using a confidential online survey was used to examine policies of health care institutions in New England as they pertain to the legal and ethical aspects of third-party access to medical records of clinical research participants. A wide variation in institutional policies was found, and some were non-compliant with applicable laws, regulations, and/or basic ethical principles.

背景与目标： : 源文件验证 (SDV) 是临床试验中监测活动的基本和重要组成部分。在大多数情况下，SDV涉及第三方或不是负责病历存储和维护的医疗保健机构雇员的个人对病历进行检查。因此，对于医疗保健机构而言，确保其第三方访问政策符合适用的准则，法律和法规至关重要。使用机密在线调查的定量横断面研究设计用于检查新英格兰医疗机构的政策，因为这些政策与第三方获取临床研究参与者病历的法律和道德方面有关。发现机构政策存在很大差异，有些政策不符合适用的法律，法规和/或基本道德原则。

BACKGROUND & AIMS: BACKGROUND:Although considerable attention has been given to the establishment of enrichment programs, almost none has focused on evaluating their effectiveness. PURPOSE:To assess whether or not skills acquired during enrichment programs contributed to students' academic success in medical school. METHODS:Success in medical school, as characterized by lack of delaying events (DE), student status, and United States Medical Licensing Examination-Step I scores were analyzed using a general linear model procedure to determine the effect of participation in 1 or more enrichment programs. Proportional program participation was analyzed using a chi-square test of equal proportion. RESULTS:Participants from the "serious research" enrichment programs experienced significantly fewer DE (p <.01), which contributed to student success. Some enrichment programs had disproportionately higher attendance. CONCLUSIONS:Participation in research-based enrichment programs for matriculating students who are "at risk" may develop critical thinking and problem-solving skills that help students to minimize DE.

背景与目标：

BACKGROUND & AIMS: The variations of concentrations of hexachloro-cyclohexane (HCHs), dichloro diphenyl trichloroethane (DDTs) in surface sediments from the Changjiang Estuary and Zhejiang coastal area suggests that although there is a substantial decrease of these persistent trace compounds since the last two decades, they still presented in recent surface sediments. Their concentration levels in suspended matter are still quite high. In dated sedimentary cores, the DDTs and HCHs concentration peaks appeared in 1960s to 1980s, which approximately corresponded to their production and usage history.

背景与目标： 长江口和浙江沿海地区表层沉积物中六氯环己烷 (HCHs)，二氯二苯基三氯乙烷 (DDTs) 的浓度变化表明，尽管自最近20年来，这些持久性痕量化合物已大大减少，但它们仍出现在最近的表层沉积物中。它们在悬浮物中的浓度水平仍然很高。在过时的沉积岩心中，滴滴涕和六氯环己烷的浓度峰与20世纪80年代20世纪60年代出现，这与它们的生产和使用历史大致相对应。

BACKGROUND & AIMS: AIM:To investigate the suitability of using routine height and weight data from records within a school health service system, for population monitoring of child and adolescent growth on a national level. METHODS:A longitudinal study from age 7 to 18 years of all children born on the 15th of any month in 1973 and living in Sweden on 31 December 1989 (1,724 girls and 1,855 boys). Data were collected from school health records. RESULTS:Descriptive statistics for height and weight calculated from data obtained from school health records are summarized and compared with previous Swedish studies. The effect of exclusion of children with chronic diseases involving major growth impairment and/or exclusion of children born outside Sweden have a minor impact on the results owing to the relatively small number of excluded children. CONCLUSION:Longitudinal data for somatic growth (height and weight) from age 7 to 18 years from a nationally representative sample of children in Sweden, collected from school health records, can be used for epidemiological monitoring of growth with fewer missing individuals and at lower costs compared with other dedicated studies. Data quality is comparable to similar national surveys. The data are suitable for descriptive analysis of growth and other forms of observational study.

背景与目标：