Little J M
Department of Surgery, Westmead Hospital, New South Wales, Australia.
Aust N Z J Surg. 1992 May;62(5):327-32. doi: 10.1111/j.1445-2197.1992.tb07198.x.
Modern science is preoccupied with basic mechanisms at the level of the gene, molecule, atom and fundamental particle. This preoccupation has affected attitudes to medical science. Paradoxically, politicians and Departments of Health are largely concerned with clinical epiphenomena--outcomes, interventions, effectiveness, efficiency--that are often disregarded by medical scientists and viewed without favour by granting bodies. In the surgical sciences, there is renewed interest in clinical research. The small computer and the readily available database with its compatible statistical package have added a new dimension to clinical research. Database design and analysis are as much a part of the surgical investigator's skills as are laboratory techniques. There are simple rules that govern database design. The database should be simple and flexible, but provide an adequate patient profile. Entry should be standardized by precise inclusion criteria and precise definitions. Data input should be numerical whenever possible. The database program should convert simply to a comprehensive statistical program. The clinical database is useful for both observational and investigational studies. Case series, case control studies and cohort studies can all be developed from well maintained databases. In the Department of Surgery at Westmead Hospital, databases have been maintained for 10 years. The hepatobiliary and pancreatic group of databases have led to 34 publications. The liver tumour database has produced 12 studies and nearly 20 papers. The process of development of one study is outlined in detail. The chance observation of an excess incidence of gallstones in patients having regular ultrasound examinations after major abdominal surgery has been confirmed in a case control study.(ABSTRACT TRUNCATED AT 250 WORDS)
现代科学专注于基因、分子、原子和基本粒子层面的基本机制。这种专注影响了人们对医学科学的态度。矛盾的是，政治家和卫生部主要关注临床附带现象——结果、干预措施、有效性、效率——而医学科学家往往忽视这些，资助机构也不看好这些。在外科科学领域，人们对临床研究重新产生了兴趣。小型计算机以及配有兼容统计软件包的现成数据库为临床研究增添了新的维度。数据库设计和分析与实验室技术一样，都是外科研究者技能的一部分。有一些简单的规则来指导数据库设计。数据库应该简单且灵活，但要提供足够的患者资料。录入应通过精确的纳入标准和精确定义进行标准化。数据输入应尽可能采用数字形式。数据库程序应能简单地转换为综合统计程序。临床数据库对观察性研究和调查性研究都很有用。病例系列研究、病例对照研究和队列研究都可以从维护良好的数据库中开展。在韦斯特米德医院外科，数据库已经维护了10年。肝胆胰数据库组已经产生了34篇出版物。肝脏肿瘤数据库已经开展了12项研究并发表了近20篇论文。详细概述了一项研究的开展过程。在一项病例对照研究中证实了在腹部大手术后定期进行超声检查的患者中胆结石发病率过高这一偶然观察结果。（摘要截选至250词）
