The Area Under an ROC Curve
A rough guide for classifying the accuracy of a diagnostic
test is the traditional academic point system:
- .90-1 = excellent (A)
- .80-.90 = good (B)
- .70-.80 = fair (C)
- .60-.70 = poor (D)
- .50-.60 = fail (F)
2012年5月6日 星期日
Diagnosis of Diabetes Mellitus and Metabolic syndrome
糖化血紅素(Glycated hemoglobin)：成人血紅素分為HbA(97%)、HbAB2b(2.5%)、HbF(0.5%)，成人血紅素與葡萄糖的共價結合，稱為糖化血紅素約佔HbA 7%，其中HbA1C又佔糖化血紅素中的60%，為血紅素β鏈的valine(纈氨酸)與葡萄糖結合，糖化血色素則反應出採血前3個月左右的血糖控制狀況，正常的 HbA1c約為4-6％，糖尿病人宜控制在7％以下，若能有效控制並降低糖化血色素的值，則每降低1%，罹患眼睛、心臟、血管、腎臟等病變的機率，就可降低25%。
Metabolic syndrome：
Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following:[12]
- Fasting plasma glucose (FPG) level ≥ 7.0 mmol/l (126 mg/dl)
- Plasma glucose ≥ 11.1 mmol/l (200 mg/dL) two hours after a 75 g oral glucose load as in a glucose tolerance test(OGTT)
- Symptoms of hyperglycemia and casual plasma glucose ≥ 11.1 mmol/l (200 mg/dl)
- Glycated hemoglobin 糖化血紅素 (Hb A1C) ≥ 6.5%[2]
糖化血紅素(Glycated hemoglobin)：成人血紅素分為HbA(97%)、HbAB2b(2.5%)、HbF(0.5%)，成人血紅素與葡萄糖的共價結合，稱為糖化血紅素約佔HbA 7%，其中HbA1C又佔糖化血紅素中的60%，為血紅素β鏈的valine(纈氨酸)與葡萄糖結合，糖化血色素則反應出採血前3個月左右的血糖控制狀況，正常的 HbA1c約為4-6％，糖尿病人宜控制在7％以下，若能有效控制並降低糖化血色素的值，則每降低1%，罹患眼睛、心臟、血管、腎臟等病變的機率，就可降低25%。
Metabolic syndrome：
|
危 險 因 子
|
異 常 值
|
|
腹部肥胖(Central obesity)
|
腰圍（waist）:
男性 ≧
|
|
血壓(BP)上升
|
SBP ≧130 mmHg / DBP ≧85 mmHg
|
|
高密度酯蛋白膽固醇 (HDL-C)過低
|
男性 <
|
|
空腹血糖值(Fasting glucose)上升
|
FG ≧100 mg/dl
|
|
三酸甘油酯(Triglyceride)上升
|
TG ≧150 mg/dl
|
2012年5月4日 星期五
研究設計與統計方法
Continuous variables 連續變項
Student's t test = paired t test = repeat test ：two dependent sample, or two sample's variances are equal
unpaired t test = independent t test：two independent samples, or two sample's variances are unequal
One way ANOVA used for 3 or more independent variables
non-parametric analysis(用於n<30)
Wilcoxon rank sum test 排序總和檢定(or Mann-Whitney U, 小樣本 兩組樣本皆<10, 或大樣本 任一組樣本數>10 ) used for two independent samples
Wilcoxen signed-rank test used for two dependent non-parametric samples
Kruskal-Wallis test used for 3 or more independent non-parametric samples
Freidman test used for 3 or more dependent non-parametric samples
Binominal or categorical variables 二項式或類別變項
Chi-square used in large one sample (compared with hypothesis)
Pearson Chi-square (goodness of fit test) for two independent larger groups, Yate's continuity correction p value)
Fisher exact used in small independent samples (non-parametric analysis)
McNemar's test for two small dependent groups (non-parametric analysis)
相關之統計方法
參考資料：
1. Wilcoxon rank sum test http://homepage.ntu.edu.tw/~clhsieh/biostatistic/10/10-2.htm
2. 研究設計與統計方法
http://www1.cgmh.org.tw/intr/intr2/ebmlink/doc/%E7%B5%B1%E8%A8%88%E6%95%99%E5%AD%B89411.pdf
Continuous variables 連續變項
Student's t test = paired t test = repeat test ：two dependent sample, or two sample's variances are equal
unpaired t test = independent t test：two independent samples, or two sample's variances are unequal
One way ANOVA used for 3 or more independent variables
non-parametric analysis(用於n<30)
Wilcoxon rank sum test 排序總和檢定(or Mann-Whitney U, 小樣本 兩組樣本皆<10, 或大樣本 任一組樣本數>10 ) used for two independent samples
Wilcoxen signed-rank test used for two dependent non-parametric samples
Kruskal-Wallis test used for 3 or more independent non-parametric samples
Freidman test used for 3 or more dependent non-parametric samples
Binominal or categorical variables 二項式或類別變項
Chi-square used in large one sample (compared with hypothesis)
Pearson Chi-square (goodness of fit test) for two independent larger groups, Yate's continuity correction p value)
Fisher exact used in small independent samples (non-parametric analysis)
McNemar's test for two small dependent groups (non-parametric analysis)
相關之統計方法
參考資料：
1. Wilcoxon rank sum test http://homepage.ntu.edu.tw/~clhsieh/biostatistic/10/10-2.htm
2. 研究設計與統計方法
http://www1.cgmh.org.tw/intr/intr2/ebmlink/doc/%E7%B5%B1%E8%A8%88%E6%95%99%E5%AD%B89411.pdf
2012年5月3日 星期四
期刊報告-101.5
Hyperbaric oxygen therapy as an adjunctive treatment for sternal infection and osteomyelitis after sternotomy and cardiothoracic surgery
http://www.cardiothoracicsurgery.org/content/pdf/1749-8090-6-141.pdf
Note：
1. 此研究非 RCT，由於sampling for population in control group 未清楚描述，因此擔心可能因立意收案而造成 biases of outcomes。
2.此paper應該歸為clinical investigation and analysis，非為clinical study，其調查結果可為下次研究的基石與相互驗證。
Hyperbaric oxygen therapy as an adjunctive treatment for sternal infection and osteomyelitis after sternotomy and cardiothoracic surgery
Abstract
Purpose
A retrospective study to evaluate the effect of hyperbaric oxygen (HBO2) therapy on sternal infection and osteomyelitis following median sternotomy.
Materials and methods
A retrospective analysis of patients who received sternotomy and cardiothoracic surgery which developed sternal infection and osteomyelitis between 2002 and 2009. Twelve patients who received debridement and antibiotic treatment were selected, and six of them received additional HBO2 therapy. Demographic, clinical characteristics and outcome were compared between patients with and without HBO2 therapy.
Results
HBO2 therapy did not cause any treatment-related complication in patients receiving this additional treatment. Comparisons of the data between two study groups revealed that the length of stay in ICU (8.7 ± 2.7 days vs. 48.8 ± 10.5 days, p < 0.05), duration of invasive (4 ± 1.5 days vs. 34.8 ± 8.3 days, p < 0.05) and non-invasive (4 ± 1.9 days vs. 22.3 ± 6.2 days, p < 0.05) positive pressure ventilation were all significantly lower in patients with additional HBO2 therapy, as compared to patients without HBO2 therapy. Hospital mortality was also significantly lower in patients who received HBO2 therapy (0 case vs. 3 cases, p < 0.05), as compared to patients without the HBO2 therapy.
Conclusions
In addition to primary treatment with debridement and antibiotic use, HBO2 therapy may be used as an adjunctive and safe treatment to improve clinical outcomes in patients with sternal infection and osteomyelitis after sternotomy and cardiothoracic surgery.
Keywords:
hyperbaric oxygen; sternal infection; osteomyelitis; sternotomy; Cardiothoracic surgeryhttp://www.cardiothoracicsurgery.org/content/pdf/1749-8090-6-141.pdf
Note：
1. 此研究非 RCT，由於sampling for population in control group 未清楚描述，因此擔心可能因立意收案而造成 biases of outcomes。
2.此paper應該歸為clinical investigation and analysis，非為clinical study，其調查結果可為下次研究的基石與相互驗證。
期刊報告 - 文秀- 101.5月
Dose-response curve to
salbutamol during acute and chronic treatment with formoterol in COPD
Background:
Use of short-acting β2-agonists in chronic obstructive
pulmonary disease (COPD) during treatment with long-acting β2-agonists is
recommended as needed, but its effectiveness is unclear. The purpose of this
study was to assess the additional bronchodilating effect of increasing doses
of salbutamol during acute and chronic treatment with formoterol in patients with
COPD.
Methods:
Ten patients with COPD underwent a dose-response curve to
salbutamol (until 800 μg of cumulative dose) after a 1-week washout (baseline),
8 hours after the first administration of formoterol 12 μg (day 1), and after a
12-week and 24-week period of treatment with formoterol (12 μg twice daily by
dry powder inhaler). Peak expiratory flow, forced expiratory volume in one
second (FEV1), forced vital capacity, and inspiratory capacity were measured at
the different periods of treatment and at different steps of the dose-response
curve.
Results:
Despite acute or chronic administration of formoterol,
maximal values of peak expiratory flow, FEV1, and forced vital capacity after
800 μg of salbutamol were unchanged compared with baseline. The baseline FEV1 dose-response
curve was steeper than that at day 1, week 12, or week 24 (P , 0.0001). Within
each dose-response curve, FEV1 was different only at baseline and at day 1 (P ,
0.001), when FEV1 was still greater at 800 μg than at 0 μg (P , 0.02). In
contrast, the forced vital capacity dose-response curves were similar at the
different periods, while within each dose-response curve, forced vital capacity
was different in all instances (P , 0.001), always being higher at 800 μg than
at 0 μg (P , 0.05).
Conclusion:
In patients with stable COPD, the maximal effect of
salbutamol on peak expiratory flow, FEV1, and forced vital capacity was
unchanged after either acute or chronic treatment with formoterol. With
increasing doses of salbutamol, FEV1 increased only after acute administration of
formoterol. Forced vital capacity also significantly improved during long-term treatment
with formoterol.
※ 使用Formoterol (LABA)可改善COPD病人的FEV1(D1,W12,W24 vs. Baseline)，但合併使用Salbutamol (SABA)則只能改善FVC(改善air-trapping的狀況),而FEV1的改善則有限(因COPD病人是FLOW LIMITATION)。
LinK：http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157942/pdf/copd-6-399.pdf
LinK：http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157942/pdf/copd-6-399.pdf
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