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Chinese Journal Of Hospital Statistics
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2024 Vol. 31, No. 4
Published: 2024-08-25
241
Influencing factors of hospitalization costs in 1 053 patients with chronic obstructive pulmonary disease
Xie Ziqing
DOI: 10.3969/j.issn.1006-5253.2024.04.001
Guide::
Objective
To investigate the factors affecting hospitalization costs of hospitalized patients with chronic obstructive pulmonary disease (COPD), so as to reduce the burden of patients, promote the rational allocation of medical resources, and provide a basis for formulating healthcare policies.
Methods
The medical record homepage data of chronic obstructive pulmonary hospitalized patients in a tertiary general hospital in Beijing from 2019 to 2022 were selected to study the influencing factors of the hospitalization costs through descriptive analysis, rank sum test, correlation analysis, and multifactor regression analysis.
Results
Male patients (66.0%) outnumbered female patients (34.0%) among 1 053 COPD patients, the proportion of patients aged 60-89 years old was the highest (82.8%), the number of medicare-paid patients was the highest (88.2%), emergency admissions (57.1%) were higher than outpatient admissions (42.9%), and the percentage of hospitalization days with 10-19 days was the the most (45.3%). The high incidence seasons of chronic obstructive pulmonary disease were fall and winter (51.9%), and common comorbidities were coronary heart disease (78.3%), hypertension (73.0%), and pulmonary heart disease (48.5%). Chinese and Western medicine (36.75%), medical services (29.57%), and diagnosis (22.82%) accounted for the largest share of hospitalization costs. There was a statistical difference in hospitalization costs for variables of age, medical payment method, number of hospitalization days, comorbidities of hypertension, coronary heart disease, respiratory failure, pulmonary heart disease, treatment with antimicrobials, and ventilator-assisted therapy (P<0.05) . Regression analysis showed that the older the age, the longer the hospitalization days, the higher the number of comorbidities, the more use of antimicrobial drugs and ventilator therapy, the higher the hospitalization costs. Compared to medical insurance patients, public medical care was positively correlated with hospitalization costs (P<0.05).
Conclusion
Health education should be strengthened, early screening and intervention for elderly patients and COPD patients with a history of cardiovascular disease should be carried out, and multidisciplinary diagnostic and treatment modes and improved clinical pathways should be utilized to standardize the diagnostic and treatment processes, logically shorten the average number of hospitalization days, reduce the waste of medical resources and alleviate the patients′ economic burden.
2024 Vol. 31 (4): 241-247 [
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Average hospitalization costs per-time of patients with depression based on new grey correlation and degree of structural variation
Chen Jingjing，Shi Wenqi，Chen Xiaodong，Chen Xiaoxia，Liu Zifeng，Deng Shumin
DOI: 10.3969/j.issn.1006-5253.2024.04.004
Guide::
Objective
To explore the structure and importance ranking of average hospitalization costs for patients with depression, and to provide a basis for improving the structure of patients′ hospitalization costs and effective cost control.
Methods
Information on the hospitalization costs of patients with depression in a tertiary hospital in Guangzhou City from 2018 to 2023 was collected, and the degree of association, composition ratio, and change of each cost with the average hospitalization costs per-time were evaluated by using the degree of structural variation and new gray correlation analysis.
Results
From 2018 to 2023, the average hospitalization cost per-time of patients with first gradually increased and then decreased, the proportion of diagnostic fee and examination fee continued to increase, and the proportion of nursing fee and drug fee continued to decrease. The degree of structural change of average hospitalization cost per-time during the 6-year period was 33.84%, and the degree of annual average structural change was 5.64%. The top 3 contributors to the structural change were drug fee (26.77%), diagnostic fee (23.43%) and medical service fee (19.77%), and the cumulative contribution of the three amounted to 69.97%. The results of the new gray correlation analysis showed that the treatment fee (0.939) had the greatest impact on the average hospitalization cost per-time of depressed patients, followed by the diagnostic fee (0.883), the examination fee (0.866) and the medical service fee (0.817).
Conclusion
Treatment fee, diagnostic fee and examination fee are the main factors affecting the hospitalization cost of depressed patients, and the income of nursing fee and drug fee continues to decrease. It is recommended to continuously optimize the cost structure and establish a reasonable, stable and efficient cost control program.
2024 Vol. 31 (4): 248-252 [
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Impact of age and surgical approach on hospitalization costs of lung cancer patients undergoing surgery based on DRG grouping
Zeng Xiangman
DOI: 10.3969/j.issn.1006-5253.2024.04.003
Guide::
Objective
To analyze the impact of age and surgical procedures on hospitalization costs for lung cancer patients undergoing surgery.
Methods
The study focused on surgical patients who were primarily diagnosed with lung cancer (C34.) in a tertiary hospital in Ningbo from January 1, 2022 to December 31, 2022, and analyzed their DRG enrollment status. Differential analysis of patient costs in the DRG group using t-test and analysis of variance based on age and surgical procedures.
Results
A total of 2 489 lung cancer surgery patients were all assigned to the EB1 chest surgery group. There was no statistically significant difference (P>0.05) in the impact of age and surgical procedures on patient costs between EB11 major chest surgery with severe complications and comorbidities. The hospitalization costs of patients over 60 years old in the group of EB13 major chest surgery with general complications and comorbidities and in the group of EB15 major chest surgery without complications and comorbidities were significantly higher than those of patients under 60 years old (P<0.05). As age increased, hospitalization costs increased, and the amount of medical insurance losses in hospitals increased, with statistical significance (P<0.05). Except for no difference in hospitalization costs between lobectomy and total pneumonectomy, there was a statistically significant difference in hospitalization costs among other surgical procedures in the EB13 group (P<0.05). Except for no difference in hospitalization costs between partial lobectomy, lobectomy and pneumonectomy, all other surgical procedures showed statistically significant differences (P<0.05) in the EB15 group. As the surgical resection range increased, hospitalization costs increased, the medical insurance losses increased in the hospital, and the difference was statistically significant (P<0.05).
Conclusion
The hospitalization costs of lung cancer patients undergoing surgery are greatly influenced by age and surgical procedures. When optimizing the DRG grouping scheme, it is necessary to improve the compatibility with clinical practice and further refine it with full consideration of the actual clinical situation.
2024 Vol. 31 (4): 253-257 [
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Inpatient death case analysis in a tertiary comprehensive hospital from 2020 to 2022
Sun Li
DOI: 10.3969/j.issn.1006-5253.2024.04.004
Guide::
Objective
To analyze inpatient death cases in a tertiary comprehensive hospital during the threeyear period from 2020 to 2022 and provide reference data for the evaluation of the hospital′s ability to treat difficult and critical cases.
Methods
The basic information of all inpatient deaths during the three-year period from 2020 to 2022 was collected using the hospital′s medical record statistical management system. The cases were classified according to the International Classification of Diseases (ICD-10) and analyzed using statistical analysis software SPSS 23.0.
Results
From 2020 to 2022, there were a total of 306 756 discharged patients and 1 522 inpatient deaths, with a total mortality rate of 4.96‰. The mortality rate showed a decreasing trend each year, and there were significant differences in mortality rates between the years(χ2=18.470, P<0.001). The mortality rate of male patients was 6.35‰, higher than that of female patients (3.57‰), and the difference was statistically significant(χ2=119.501, P<0.001).There were differences in mortality rates among different age groups. The group with the highest mortality rate was the newborn group (less than 28 days old), with a mortality rate of 30.91‰. The second highest mortality rate was in the age group over 80 years old, with a mortality rate of 17.84‰. The differences in mortality rates between different age groups were statistically significant(χ2=1 367.76, P<0.001). The top three causes of death in hospitalized patients were circulatory system diseases (24.24%), respiratory system diseases (21.16%), and malignant neoplasms (20.83%). The causes of death were different between age groups. In the newborn group (under 28 days), some conditions originating in the perinatal period were the main cause of death. The group aged 28 days to under 1 year old had the highest number of deaths due to respiratory diseases, while malignant tumors and circulatory system diseases were the main causes of death in the age group between 20 and 79 years old, and respiratory system diseases and circulatory system diseases were the main causes of death for those aged 80 years old and above.
Conclusion
Circulatory system diseases, respiratory system diseases, and malignant tumors were the main causes of death. According to the distribution of causes of death, medical institutions should strengthen the prevention and treatment of chronic diseases, carry out personalized health interventions and health education, and reduce the risk of disease in high-risk groups; at the same time, according to the characteristics of different diseases, they should optimize the diagnosis and treatment process, strengthen the allocation of medical resources, and continuously improve the quality of medical services.
2024 Vol. 31 (4): 258-262 [
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Characteristics of respiratory inpatients in a tertiary hospital in Hainan Province from 2019 to 2023
Ye Wanling，Lu Weifeng
DOI: 10.3969/j.issn.1006-5253.2024.04.005
Guide::
Objective
To investigate the composition and change of respiratory diseases in a tertiary hospital in Hainan Province, and to provide reference for scientific prevention and control of diseases, dynamic allocation of medical resources and discipline development planning.
Methods
The home page information of respiratory patients in a tertiary hospital in Hainan Province from 2019 to 2023 was selected, and the diseases were classified according to ICD-10 classification standard, and the gender, age, disease distribution and seasonal distribution of inpatients were retrospectively analyzed.
Results
A total of 25 003 inpatients were hospitalized from 2019 to 2023, with a male/female ratio of 1.60∶1; the majority of inpatients were middle-aged and the elderly, the least were children and adolescents, but the proportion of both increased year by year; the most patients were hospitalized in winter and the least in autumn; the rank change of inpatient diseases was statistically significant (P<0.001), influenza and pneumonia always ranked first, chronic lower respiratory diseases showed a downward trend year by year, and other diseases of respiratory system showed an upward trend year by year; the inpatient diseases were mainly influenza and pneumonia (48.2%), the proportion of inpatient diseases in infants (0-3 years old) was the highest (81.9%), and the proportion of inpatient diseases in adolescents (7-17 years old) was the lowest (37.3%).
Conclusion
It is necessary to strengthen health education, improve disease cognition, dynamically allocate medical resources according to the distribution of diseases, and strengthen the discipline construction and special disease management of pediatrics, geriatrics and respiratory medicine.
2024 Vol. 31 (4): 263-267 [
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Analysis of death cases of elective surgery patients in a hospital from 2020 to 2022
Liang Danmei，Gong Xiaoling，Lu Ting，Chen Mengting，Huang Qingwen
DOI: 10.3969/j.issn.1006-5253.2024.04.006
Guide::
Objective
To understand the influencing factors of perioperative death of elective surgery patients in a hospital, and to provide data reference for hospitals to strengthen perioperative management and reduce postoperative mortality.
Methods
The information of patients who underwent elective surgery from January 1, 2020 to December 31, 2022 was retrieved from the medical record homepage management system of a tertiary general hospital, and the main diagnosis, surgical method, surgical department and causes of postoperative death were retrospectively analyzed.
Results
From 2020 to 2022, 81 722 patients underwent elective surgery in the hospital, of which 103 patients died after the surgery, with a mortality rate of 0.13%; the top three primary diseases were circulatory system disease, tumor minor and congenital disease, accounting for 85.43%; the main surgical types of patients who died after elective surgery cardiac surgery, aortic surgery and craniocerebral surgery, accounting for 46.07%; postoperative death cases were mainly concentrated in the departments of cardiothoracic surgery, cardiovascular surgery, cardiovascular medicine, vascular surgery, neurosurgery and intervention; the main cause of death was surgical complications, accounting for 44.66%, followed by primary disease aggravation and other diseases after the surgery, accounting for 32.04% and 23.30% respectively.
Conclusion
The relevant surgical departments should strengthen the management of preoperative, intraoperative and postoperative perioperative patients. The functional departments should carry out special management for the departments with more deaths of elective postoperative patients, which is of great significance to reduce the postoperative mortality of patients undergoing elective surgery.
2024 Vol. 31 (4): 268-272 [
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Comparative analysis of operational efficiency of public hospitals in Jiangsu Province from 2015 to 2022 based on DEA
Chen Anqi，Zeng Xiang
DOI: 10.3969/j.issn.1006-5253.2024.04.007
Guide::
Objective
To analyze the operation index data of public hospitals in Jiangsu Province, in order to provide insights for optimizing resource allocation and management of medical resources in public hospitals in Jiangsu Province.
Methods
Data envelopment analysis (DEA) was employed to assess the operational efficiency of second-level and above public hospitals in sub-cities of Jiangsu from 2015 to 2022.
Results
From 2015 to 2019, the technical efficiency, scale efficiency and comprehensive efficiency of public hospitals in Jiangsu Province were all 1, indicating that DEA was strong and effective, while the return to scale remained unchanged. From 2020 to 2022, except for 2021, when the technical efficiency was 1, the scores of technical efficiency, scale efficiency and comprehensive efficiency were less than 1, and in 3 years, the scale efficiency and comprehensive efficiency were not effective. Notably, Suzhou, Zhenjiang, and Suqian maintained a scale compensation coefficient of 1 from 2015 to 2022, while other areas experienced fluctuations in scale compensation.
Conclusion
The operational efficiency of public hospitals in Jiangsu Province varies over time and across regions, indicating uneven development. There is still room for optimizing the allocation of medical resources and scale among public hospitals in many cities.
2024 Vol. 31 (4): 273-277 [
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Hospitalization expense analysis and comprehensive evaluation of medical service performance before and after the implementation of DIP payment reform
Dai Shiyuan，Nie Zhao，Shen Quanping，Min Dingyu，Chen Ying，Yu Qidi，Ao Shuang
DOI: 10.3969/j.issn.1006-5253.2024.04.008
Guide::
Objective
To compare the changes in hospitalization expenses before and after the implementation of DIP payment reform measures in hospitals, and further analyze and evaluate the performance of medical services.
Methods
The data of the first quarter of 2023 before DIP payment reform and the data of the first quarter of 2024 after DIP payment implementation in a hospital were collected in this research to analyze the the changes in hospitalization expenses and medical service performance.
Results
After DIP payment reform, the total hospitalization expense and the out-of-pocket expense for patients were significantly reduced, and the difference was statistically significant (P<0.05). The ratio of medical expenses was significantly increased, and medical service performance indicators such as CMI, total DRG, time consumption index, cost consumption index, and low-risk mortality rate were improved.
Conclusion
DIP payment reform is effective in controlling hospitalization expenses, reducing patients′ out-of-pocket expenses, building acceptable hospitalization expense structure, and significantly improving medical services performance.
2024 Vol. 31 (4): 278-280 [
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Latent profile analysis of perceived climate of team Cha-xu among clinical nurses and its influence on job withdrawal behavior
Zhang Jiali，Wang Danliang，Qiu Xiaohui
DOI: 10.3969/j.issn.1006-5253.2024.04.009
Guide::
Objective
To explore the latent profile category of team Cha-xu among clinical nurses and its influence on job withdrawal behavior, and provide some reference for the management of clinical nurses.
Methods
Clinical nurses were selected from two tertiary hospitals in Wenzhou, Zhejiang Province from January to April 2023 by convenience sampling. The basic data questionnaire, perceived climate of team Cha-xu scale and job withdrawal behavior scale were used in the investigation.
Results
A total of 392 clinical nurses were included in the study. The score of perceived climate of team Cha-xu in clinical nurses was 41.15±8.07. The model fitting effect of three latent profile categories was best, namely "insider" with low scores, accounting for 28.06%; "intermediate", accounting for 41.07% and "outsider" with higher scores, accounting for 30.87%. Nurses with different professional titles, work relationship and monthly income showed significant differences in perceived climate of team Cha-xu (P<0.05). The score of job withdrawal behavior was 18.13±3.39. The nurses in different perceived climate of team Cha-xu category had different job withdrawal behaviors (F=4.883, P<0.05). The pairwise comparison results showed that there was no significant difference between "insider" and "middleman" (P>0.05), while there was significant difference between "outsider" and "insider", "outsider" and "middleman" (P<0.05).
Conclusion
Nursing managers should pay attention to the impact of perceived climate of team Cha-xu on job withdrawal behaviors, strive to improve their own management level, create a harmonious working atmosphere, and give clinical nurses full support and care, so as to reduce the perceived climate of team Cha-xu and the job withdrawal behavior.
2024 Vol. 31 (4): 281-285 [
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Study of the mediating role of psychological security in the effect of respectful leadership on employee satisfaction in public hospitals
Yang Wanhong，Chen Jing，Li An，Li Junyang，Jiang Yizhen
DOI: 10.3969/j.issn.1006-5253.2024.04.010
Guide::
Objective
To explore the relationship between respectful leadership, psychological security and employee satisfaction, in order to provide reference for hospital managers to improve employee satisfaction.
Methods
Respectful leadership scale, psychological safety scale and job satisfaction scale were used to conduct a questionnaire survey on employees for descriptive analysis, correlation analysis and a structural equation model was constructed based on the results.
Results
The total score of respectful leadership was (45.82±10.25), psychological safety was (17.31±3.43) and employee satisfaction was (26.90±5.88). Pearson correlation analysis showed that there was a significant positive correlation between the three variables, and the absolute value of correlation coefficient ranged from 0.335 to 0.583 (P<0.01). Respectful leadership had no direct predictive effect on employee satisfaction (β=0.05, P>0.05), the indirect effect coefficient of respectful leadership on employee satisfaction was 0.35, the total effect coefficient was 0.40, and the mediating effect accounted for 87.5%. This indicates that respectful leadership indirectly affects employee satisfaction through psychological safety.
Conclusion
Psychological safety plays an mediating role in the relationship between respectful leadership and employee satisfaction. The management departments can evaluate the performance of respect for subordinates by leaders, advocate respectful leadership, and improve the psychological security and satisfaction of employees.
2024 Vol. 31 (4): 286-290 [
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Analysis of the effect and influencing factors of the training on rational hypertension drug administration for community doctors
Yang Maolin，Zheng Yongjun，Liang Jingrong，Yu Weichang，Lin Hai，Zhang Nanxiang，Chen Siyang，Luo Hao，Zhang Jinxin，Li Haiyan
DOI: 10.3969/j.issn.1006-5253.2024.04.011
Guide::
Objective
To evaluate the training effect of "guidelines for rational drug use of hypertension for community doctors designed based on current drug use", and to explore the factors influencing training effects of community doctors, so as to provide reference for further improving and perfecting the training of community doctors.
Methods
A questionnaire survey was conducted to investigate the demographic information, knowledge level for rational hypertension drug administration before and after the training and satisfaction with the community doctors participating in the training. The demographic information and satisfaction level were analyzed with descriptive statistics. The training effect analysis was conducted with Wilcoxon signed-rank test, and influencing factors for training effects were explored with logistic regression.
Results
Compared with that before the training, the number of wrong answers after the training was significantly reduced (M(P25, P75) as 6(4, 9), P＜0.05). Educational background, marital status and the number of wrong answers before the training were independent influencing factors for the training effect (P＜0.05). The past training opportunities, subjective evaluations, and mastery of professional knowledge of community doctors are significantly correlated with training effectiveness (P＜0.05).
Conclusion
The effectiveness for this training was considerable, and most community doctors were satisfied with this training, which indicates that the training designed according to current medication situations and relevant domestic guidelines can effectively improve the knowledge level of community doctors about rational hypertension drug administration.
2024 Vol. 31 (4): 291-297 [
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Investigation on the status and influencing factors of medication near-miss reporting barriers of nurses
Liu Wenjuan，Han Xiaping，Chen Meijuan
DOI: 10.3969/j.issn.1006-5253.2024.04.012
Guide::
Objective
To investigate and analyze the status of medication near-miss reporting barriers of nurses, and analyze its influencing factors.
Methods
In October, 2023, 285 clinical nurses were investigated and analyzed by stratified cluster sampling method with the general situation questionnaire, the reporting disorder scale of nurses′ drug approach error and the scale of nurses′ organizational climate perception.
Results
The total mean score of nurse medication near-miss reporting barriers was (3.80±0.51) (The average score of the scale is 1 to 6 points, the higher the score indicates the more serious the reporting disorder), and the total mean score of nurses′ organizational climate perception was (3.16±0.45) (The scale is divided into 1 to 4 points, the higher the score, the better the organizational atmosphere perceived by nurses). There were statistically significant differences in the total average score of nurses′ medication near-miss reporting barriers in terms of working years, professional title and position (P<0.05). Correlation analysis showed that there was a negative correlation between the nurses′ medication near-miss reporting barriers and the total score of organizational climate perception of nurses and its various dimensions (r=-0.558,P<0.01). Multiple linear regression analysis showed that working years, job title, position, nurses′ organizational climate perception were the main influencing factors of nurses′ medication access error reporting disorder.
Conclusion
The medication near-miss reporting barriers and the organizational climate perception of nurses are above medium level. The medication near-miss reporting barriers of nurses are affected by working years, professional title, position, and organizational atmosphere, so good organizational atmosphere of the department can reduce the reporting barriers of near-miss in drug administration by nurses.
2024 Vol. 31 (4): 298-302 [
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Current status and influencing factors of evidence-based practice atmosphere among clinical nurses working in a tertiary hospital in Wenzhou
Lin Bingsi，Lu Huifang，Ye Peizhi
DOI: 10.3969/j.issn.1006-5253.2024.04.013
Guide::
Objective
To explore the current situation and influencing factors of evidence-based practice atmosphere among clinical nurses in tertiary hospitals, so as to provide theoretical basis for nursing management.
Methods
From February to March 2023, a questionnaire survey was conducted among 373 clinical nurses in a tertiary hospital in Wenzhou, Zhejiang Province by using convenience sampling method and general situation questionnaire, evidence-based practice implementation atmosphere scale, implementation leadership scale and general self-efficacy scale.
Results
The score of evidence-based practice atmosphere of clinical nurses was (2.88±0.73); there were significant differences in the scores of education, technical title, employment form and evidence-based training (P<0.05); the evidence-based practice environment of clinical nurses was positively correlated with the implementation leadership, general self-efficacy and all dimensions (P＜0.05); the results of regression analysis showed that the implementation of leadership, technical title, self-efficacy, and with evidence-based training entered the regression equation, which could explain 29.7% of the total variance.
Conclusion
The atmosphere of evidence-based practice of clinical nurses in tertiary hospitals should be improved, and nursing managers should pay attention to the construction of the atmosphere of evidence-based practice, provide systematic and standardized evidence-based nursing training, and promote the awareness of the environment of evidencebased practice for clinical nurses.
2024 Vol. 31 (4): 303-307 [
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Implementation of hospital informatization report statistics based on FineReport
Jia Meixia，Xu Danyuan，Ning Xing，Luo Yan，Jiang He，Xu Jun
DOI: 10.3969/j.issn.1006-5253.2024.04.014
Guide::
Objective
To introduce the use of FineReport to achieve hospital information report statistics, address the issue of "information silos" in hospital data, reduce repetitive data integration work, improve hospital management decision efficiency, reduce time and manpower costs, and achieve fine operation management.
Methods
Based on FineReport, combined with practical cases, the article covers database connection preparation, report design, report publishing, permission management, and access control.
Results
Authorized users can directly access reports for data viewing, downloading, and analysis, which can be consistently reused without repetitive settings.
Conclusion
The realization of hospital information report statistics based on FineReport can break down the "information silos" between departments, achieve long-term information resource sharing, full utilization, efficient analysis, and fine management of the data.
2024 Vol. 31 (4): 308-312 [
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Recent development of machine learning methods applied on statistical analysis for metabolomics data
Hao Panfeng，Pan Shuze，Qin Linyuan，Wu Xiaoyan
DOI: 10.3969/j.issn.1006-5253.2024.04.015
Guide::
Metabolomics is a disciplinary field that investigates all small-molecule metabolites within the biological organism. Utilizing advanced technological platforms such as mass spectrometry and nuclear magnetic resonance, comprehensive and high-throughput detection of metabolites can offer new avenues for early disease diagnosis, elucidation of pathogenic mechanisms, and personalized therapeutic approaches. Due to the diversity, high dimensionality, dynamics, noise, and variability inherent in metabolomics data, it poses formidable challenges for the research and development of data analysis methods. This paper aims to provide a comprehensive overview of recent advancements of machine learning methods for statistical analysis on metabolomics data, with particular focus on improved approaches. By synthesizing these methodologies, the intention is to offer a crucial foundation for effective data analysis and to fully harness the potential of metabolomics in medical research.
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