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世界核心医学期刊文摘(心脏病学分册) 2006年第2期 20-21页

作者： Lee D. S. Juurlink D. N. Laupacis A. 王亭忠 Institute for clinical evaluative sciences 2075 Bayview Ave Toronto Ont. M4N 3M5 Canada Dr.

Context: Patients with heart failure have a wide spectrum of mortality risks. To maximize the benefit of available pharmacotherapies, patients with high mortality risk should receive high rates of drug therapy. Objective: To examine patterns of drug therapy and underlying mortality risk in patients with heart failure. Design, Setting, and Patients: In the Enhanced Feedback for Effective Cardiac Treatment(EFFECT) population-based cohort(1999-2001) of 9942 patients with heart failure hospitalized in Ontario, Canada, we evaluated 1418 patients with documented left ventricular ejection fraction of 40% or less and aged 79 years or younger with low-,average-, and high-predicted risk of death within 1 year; all patients survived to hospital discharge. Administration of angiotensin-converting enzyme(ACE) inhibitors, ACE inhibitors or angiotensin II receptor blockers(ARBs), and β -adrenoreceptor antagonists was evaluated according to predicted risk of death. Main Outcome Measure: Heart failure drug administration rates at time of discharge and 90 days after hospital discharge. Results: At hospital discharge, prescription rates for patients in the low-, average-, and high-risk groups were 81% , 73% , 60% , respectively, for ACE inhibitors; 86% , 80% , 65% , respectively, for ACE inhibitors or ARBs; and 40% , 33% , 24% , respectively, for β -adrenoreceptor antagonists(all P< .001 for trend). Within 90 days following hospital discharge, the rates were 83% , 76% , and 61% for ACE inhibitors; 89% , 83% , and 67% for ACE inhibitors or ARBs; and 43% , 36% , and 28% for β -adrenoreceptor antagonists for the 3 risk groups, respectively(all P< .001 for trend). The pattern of lower rates of drug administration in those patients at increasing risk was maintained up to 1 year postdischarge(P< .001). After accounting for varying survival time and potential contraindications to therapy, low-risk patients were more likely to receive ACE inhibitors or ARBs(adjusted hazard ratio HR , 1.61; 95

关键词：心衰心衰患者 ARB 药物治疗 β受体阻断剂死亡风险不匹配

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循证药物治疗依从性和急性心肌梗死远期死亡率的关系

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世界核心医学期刊文摘（心脏病学分册） 2007年第7期3卷 4-5页

作者： Rasmussen J.N. Alter D.A. 黄浙勇 Institute for clinical evaluative sciences 2075 Bayview Ave Toronto Ont. M4N 3M5 Canada Dr.

背景：药物依从性对存活率的影响程度如何尚不为人知，部分原因在于死亡率差异可能更多地源自“健康遵从效应”行为特性，而不是药物治疗作用。目的：探讨药物治疗依从性与急性心肌梗死（AMI）存活患者死亡率的关系。设计、地点和参与... 详细信息

背景：药物依从性对存活率的影响程度如何尚不为人知，部分原因在于死亡率差异可能更多地源自“健康遵从效应”行为特性，而不是药物治疗作用。目的：探讨药物治疗依从性与急性心肌梗死（AMI）存活患者死亡率的关系。设计、地点和参与者：该观察性纵向人群研究纳入1999-2003年加拿大安大略省31455例老年AMI存活者。所有患者被予以他汀类药物、β受体阻断剂或钙通道阻断剂（钙通道阻断剂缺乏改善存活率的循证医学证据，作为对照）。主要观察指标：患者被分为依从性高（依从天数百分比≥80％）、中（依从天数百分比40％～79％）和低（依从天数百分比〈40％）三类。应用多因素生存分析和倾向分析比较其远期死亡率（中位随访2．4年），分析中校正了社会人口统计学因素、疾病严重性、共病和同时采用的循证治疗手段等因素。

关键词：药物治疗依从性远期死亡率急性心肌梗死循证医学证据钙通道阻断剂社会人口统计学 β受体阻断剂药物依从性

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冠状动脉搭桥术后长期无症状存活者的生活质量与普通人群相当

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世界核心医学期刊文摘（心脏病学分册） 2006年第6期2卷 28-29页

作者： Bradshaw P.J. Jamrozik K.D. Gilfillan I.S. Thompson P.L. 黎一兵 Institute for clinical evaluative sciences(ICES) 2075 Bayview Avenue Toronto Ont. M4N 3M5 Canada Dr.

Background: Health- related quality of life(HRQOL) among long- term survivors of coronary artery bypass surgery is an important outcome that has been little studied at the population level. Methods: A postal survey was conducted in 1999 to 2000 in patients 6 to 20 years after coronary artery bypass graft(CABG) surgery in Western Australia. A random stratified sample of 2500 was drawn from 8910 patients who had their first CABG surgery in 1980 to 1993. Health- related quality of life was measured with Short Form 36 and EuroQol visual analogue scale. Results: Response was 82% (n=2061). Health- related quality of life declined with age and was similar for men and women, although scores for women were worse for physical functioning. Compared with Australian population norms, the age- and sex- standardized scores of survivors of CABG were generally worse, mainly in the physical domain. Reported angina at the time of follow- up(33% ), symptoms of heart failure equivalent to New York Heart Association(NYHA) classes II to IV(34% ), and comorbidities such as diabetes and hypertension were associated with poorer HRQOL. For both men and women without angina or heart failure at follow- up,HRQOL was no different from that of the general population. Conclusion: Overall, the quality of life among long- term survivors of CABG is worse than that of the general population, the difference being mainly attributable to recurrent symptoms and comorbidities. Quality of life for those without angina or heart failure at follow- up was equivalent to the population norms, providing an incentive to maximize efforts to abolish angina and ameliorate heart failure symptoms.

关键词：健康相关生活质量 CABG术后冠状动脉搭桥术长期存活者普通人群无症状 HRQOL 视觉模拟评分年龄增长澳大利亚

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冠状动脉搭桥手术患者出院后结局的性别差异

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世界核心医学期刊文摘（心脏病学分册） 2006年第7期2卷 21-22页

作者： Guru V. Fremes S.E. Austin P.C. 郭俊 Institute for clinical evaluative sciences G106 2075 Bayview Ave Toronto Ont. M4N 3M5 Canada Dr.

Background -There are few comparative data regarding long-term nonfatal outcomes for women versus men after coronary artery bypass grafting(CABG). This study compares gender differences in cardiac events in a population of hospital survivors up to 11 years after isolated CABG surgery in Ontario, Canada. Methods and Results -A population-based cohort study(n=68 774 patients, 15 043 women) between September 1, 1991, and April 1, 2002, was assembled with linked clinical and administrative databases. Cox modeling and propensity score matching were used to compare death, cardiac readmission(angina, heart failure, myocardial infarction), repeat revascularization(angioplasty or CABG), and stroke readmission between men and women. Women were older(65±17 versus 62±13 years), more likely to present with urgent or emergent status(64%versus 56%), and less likely to receive arterial grafts(70%versus 78%). Women had a higher rate of cardiac readmission in the first year after surgery(hazard ratio[HR] of 1.5, 95%confidence interval[CI] 1.36 to 1.56), and this increased risk persisted after 1 year(HR 1.2, 95%CI 1.14 to 1.31). This was primarily due to readmissions for unstable angina(HR 1.3, 95%CI 1.24 to 1.38) and congestive heart failure(HR 1.1, 95%CI 1.06 to 1.21). Propensity-matched women had similar rates of death(HR 0.9, 95%CI 0.83 to 0.98) and repeat revascularization(HR 1.0, 95%CI 0.91 to 1.06). Conclusions -Women have a more complex clinical preoperative presentation and are more likely to be readmitted with unstable angina and congestive heart failure after CABG but experience survival similar to those seen in men. Gender differences in outcomes may be improved through durable revascularization strategies and close postoperative follow-up care targeted to women.

关键词：性别差异冠状动脉搭桥血运重建不稳定型心绞痛非致死性血管成形术心脏事件充血性心力衰竭患

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对存在治疗选择偏倚的观察性研究的分析:采用倾向评分和工具变量法评价有创性心脏治疗对AMI患者生存率的影响

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世界核心医学期刊文摘（心脏病学分册） 2007年第7期3卷 5-6页

作者： Stukel T.A. Fisher E.S. Wennberg D.E. 黄浙勇 Institute for clinical evaluative sciences G106 2075 Bayview Ave Toronto Ont. M4N 3M5 Canada Dr.

背景：在观察性研究中，对治疗组和非治疗组间结果的比较可能会因组间患者预后的差异而产生偏倚，常见的原因是未发现的治疗选择偏倚。目的：比较4种分析方法排除观察性研究中选择偏倚的效果：多因素模型风险校正、倾向评分风险校正、... 详细信息

背景：在观察性研究中，对治疗组和非治疗组间结果的比较可能会因组间患者预后的差异而产生偏倚，常见的原因是未发现的治疗选择偏倚。目的：比较4种分析方法排除观察性研究中选择偏倚的效果：多因素模型风险校正、倾向评分风险校正、倾向评分匹配法和工具变量法。设计、地点和患者：此项全国性队列研究纳入1994—1995年间122124例享有医疗保险的老年急性心肌梗死（AMI）住院患者（65～84岁），所有病例均适合行心导管术。基线资料来自心血管合作项目，并与医疗保险管理数据连接，以确保足够充分的预后参数。

关键词：心脏治疗倾向评分 AMI患者偏倚工具生存率有创性老年急性心肌梗死

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亲缘关系与布氏田鼠双亲行为和杀婴行为关系的初探

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兽类学报 2003年第4期23卷 326-331页

作者：于晓东房继明生物多样性与生态工程教育部重点实验室北京师范大学生态学研究所中国科学院动物研究所北京1O0O80 Institute for clinical evaluative sciences TorontoOntario M4N 3M5Canada

根据幼仔发育的 5个阶段 :新生 (1～ 5日龄 )、耳立 (6～ 9日龄 )、睁眼 (10～14日龄 )、出巢 (15～ 2 0日龄 )和断奶 (2 1～2 4日龄 ) ,通过观察布氏田鼠对自己幼仔 (r=0 5 0 )和非亲缘幼仔 (r <0 12 5 )的行为反应 ,研究亲缘关系对... 详细信息

根据幼仔发育的 5个阶段 :新生 (1～ 5日龄 )、耳立 (6～ 9日龄 )、睁眼 (10～14日龄 )、出巢 (15～ 2 0日龄 )和断奶 (2 1～2 4日龄 ) ,通过观察布氏田鼠对自己幼仔 (r=0 5 0 )和非亲缘幼仔 (r <0 12 5 )的行为反应 ,研究亲缘关系对布氏田鼠双亲和杀婴行为的影响。结果表明 :1)新生阶段 ,雄鼠抚育亲仔的时间显著多于非亲缘幼仔 ;断奶阶段 ,雄鼠与亲仔相触及在巢内活动的时间也显著多于非亲缘幼仔 ;雄鼠在耳立、出巢和断奶阶段嗅闻非亲缘幼仔 ,以及在新生和睁眼阶段修饰非亲缘幼仔的时间都显著多于亲仔。 2 )断奶阶段 ,雌鼠与亲仔相触的时间显著多于非亲缘幼仔 ,但在睁眼阶段修饰非亲缘幼仔 ,以及在新生、耳立和出巢阶段嗅闻非亲缘幼仔的时间显著多于亲仔。 3)雌雄鼠在15日龄前没有杀婴行为 ,15日龄后 ,开始对非亲缘幼仔发生杀婴行为 ;雌鼠杀婴行为受幼仔发育的显著影响 ,且杀婴频次显著高于雄鼠 ;雌鼠在断奶阶段对非亲缘幼仔的杀婴频次显著高于亲仔。综上所述 ,亲缘关系对布氏田鼠的双亲和杀婴行为有显著影响 ,这可能与个体间的已往经历 (熟悉性等 )或表现性匹配等辨别机制有关。

关键词：布氏田鼠亲缘关系熟悉性双亲行为杀婴行为

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预防医学再访Rose:减少冠心病的策略

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英国医学杂志中文版 2007年第1期10卷 44-47页

作者： Douglas G Manuel Jenny Lim Peter Tanuseputro Geoffrey M Anderson David A Alter Andreas Laupacis Cameron A Mustard 王增武（译）高润霖（校） Institute for clinical evaluative sciences G106-2075Bayview AvenueToronto ON Canada M4N 3M5 Department of PublicHealth sciences University ofToronto Toronto Institute for Work and Health Toronto

近些年来，我们评价冠心病风险的方法已经变得更精确了。这一结果是如何影响一级预防和二级预防的功效呢？

关键词：冠心病预防医学二级预防一级预防

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Determining the hospital cost of anterior epistaxis treatment modalities at a Canadian tertiary care centre

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2019年第4期5卷 193-199页

作者： Harrish Nithianandan Kednapa Thavorn Fatmahalzahra Banaz Kristian Macdonald Andrea Lasso Shaun J.Kilty Faculty of Medicine University of OttawaOttawaOntarioCanada Ottawa Hospital Research Institute(OHRI) OttawaOntarioCanada School of Epidemiology and Public Health University of OttawaOttawaOntarioCanada Institute for clinical and evaluative sciences ICES uOttawaOttawaOntarioCanada Department of Otolaryngology-Head and Neck Surgery The University of OttawaOttawaOntarioCanada Dr.S.Kilty Medicine Prof.Corp. OttawaONCanada

Objective:To estimate the hospital costs of managing anterior epistaxis in the Emergency Department at a Tertiary Care centre in *** and methods:A cost analysis was conducted based on a retrospective review of Emergency Department visits from January 2012 to May 2014.A consecutive sample of adult patients with a diagnosis of anterior epistaxis was *** epistaxis was managed via one of:Nasal clip,Merocel(R),Silver Nitrate cautery,Vaseline packing,other treatment or no *** the direct and indirect hospital costs(SCDN)for anterior epistaxis treatment were calculated from the hospital's *** linear models were used to assess the association between treatment modalities and total hospital costs while controlling for potential confounding ***:Three hundred and fifty-three patients(49%female)with a mean age of(69.9±18.5)years were included in the *** median(interquartile ranges)costs of treatment ranged from CS227.83(CS167.96,CS328.69)for observation to CS763.98(CS632.25,CS830.23)for Merocel(R).The overall median total hospital costs incurred across all modalities was CS566.24(CS459.61,CS753.46)for the management of anterior *** Nitrate,nasal clip,and observation were statistically associated with a lower cost when compared to Merocel(R)(P<0.001)even after potential confounding factors were ***:Our results show wide difference in the hospital cost of epistaxis across treatment *** cost estimates can help inform future economic evaluation studies aiming to guide the allocation of health care resources for patients with epistaxis.

关键词： Anterior epistaxis Nasal packing Cautery Silver nitrate Hospital costs

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急性心肌梗死的医保患者的介入与药物治疗强度存在地区差别的长期结果

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世界核心医学期刊文摘（心脏病学分册） 2005年第9期1卷 17-18页

作者： Stukel T.A. Lucas F.L. Wennberg D.E. 任付先 Dr. Inst. for Clin. evaluative sciences G106-2075 Bayview Ave Toronto Ont. M4N 3M5 Canada

Context: The health and policy implications of the marked regional variations in intensity of invasive compared with medical management of patients with acute myocardial infarction(AMI) are unknown. Objectives: To evaluate patient clinical characteristics associated with receiving more intensive treatment; and to assess whether AMI patients residing in regions with more intensive invasive treatment and management strategies have better longterm survival than those residing in regions with more intensive medical management strategies. Design, Setting, and Patients: National cohort study of 158831 elderly Medicare patients hospitalized with first episode of confirmed AMI in 1994-1995, followed up for 7 years(mean, 3.6 years), according to the intensity of invasive management(perfor-mance of cardiac catheterization within 30 days) and medical management(prescription of βblockers to appropriate patients at discharge) in their region of residence. Baseline chart reviews were drawn from the Cooperative Cardiovascular Project and linked to Medicare health administrative data. Main Outcome Measure: Long-term survival over 7 years of followup. Results: Patient baseline AMI severity was similar across regions. In all regions, younger and healthier patients were more likely than older high-risk patients to receive invasive treatment and medical therapy. Regions with more invasive treatment practice styles had more cardiac catheterization laboratory capacity; patients in these regions were more likely to receive interventional treatment, regardless of age, clinical indication, or risk profile. The absolute unadjusted difference in 7-year survival between regions providing the highest rates of both invasive and medical management strategies and those providing the lowest rates of both was 6.2%. For both ST-and non-ST-segment elevation AMI patients, survival improved with regional intensity of both invasive and medical management. In areas with higher rates of medical management,

关键词：治疗强度急性心肌梗死医保患者药物治疗地区差别 β受体阻断剂远期生存率介入治疗队列研究心导管室

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Discharge heart rate and 1-year clinical outcomes in heart failure patients with atrial fibrillation

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Chinese Medical Journal 2022年第1期135卷 52-62页

作者： Fuwei Xing Xin Zheng Lihua Zhang Shuang Hu Xueke Bai Danli Hu Bing Li Jing Li Department of Cardiology The First Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouGuangdong 510080China National clinical Research Center for Cardiovascular Diseases NHC Key Laboratory of Clinical Research for Cardiovascular MedicationsState Key Laboratory of Cardiovascular DiseaseFuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeNational Center for Cardiovascular DiseasesBeijing 100037China Department of Cardiology The Third Hospital of Jilin UniversityChangchunJilin 130031China

Background: The association between heart rate and 1-year clinical outcomes in heart failure (HF) patients with atrial fibrillation (AF), and whether this association depends on left ventricular ejection fraction (LVEF), are unclear. We investigated the relationship between discharge heart rate and 1-year clinical outcomes after discharge among hospitalized HF patients with AF, and further explored this association that differ by LVEF ***: In this analysis, we enrolled 1760 hospitalized HF patients with AF from the China Patient-centered evaluative Assessment of Cardiac Events Prospective Heart Failure study from August 2016 to May 2018. Patients were categorized into three groups with low (<65 beats per minute [bpm]), moderate (65-85 bpm), and high (≥86 bpm) heart rate measured at *** proportional hazard models were employed to explore the association between heart rate and 1-year primary outcome, which was defined as a composite outcome of all-cause death and HF ***: Among 1760 patients, 723 (41.1%) were women, the median age was 69 (interquartile range [IQR]: 60-77) years, median discharge heart rate was 75 (IQR: 69-84) bpm, and 934 (53.1%) had an LVEF <50%. During 1-year follow-up, a total of 792 (45.0%) individuals died or had at least one HF hospitalization. After adjusting for demographic characteristics, smoking status, medical history, anthropometric characteristics, and medications used at discharge, the groups with low (hazard ratio [HR]: 1.32, 95% confidence interval [CI]: 1.05-1.68,P = 0.020) and high (HR: 1.34, 95% CI: 1.07-1.67,P = 0.009) heart rate were associated with a higher risk of 1-year primary outcome compared with the moderate group. A significant interaction between discharge heart rate and LVEF for the primary outcome was observed (P for interaction was 0.045). Among the patients with LVEF ≥50%, only those with high heart rate were associated with a higher risk of primary outcome compared with the g

关键词： Atrial fibrillation Heart failure Heart rate Left ventricular ejection fraction

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