The marriage of clinical trials and clinical decision science

Clinical decision science is concerned with rational clinical decisions. All branches of medical research contribute here, but controlled clinical trials of the pragmatic variety carry a particular responsibility. Usually, however, they are not conducted and reported so that they can be used directly as input to a decision analysis. We suggest that the forces of the two methodologies should be united, and point out some areas where this 'marriage' will have a non-trivial impact: choice of end points, style of outcome recording, adaptive designs, and style of result presentation. Special attention is given to the decision-analytic setting of research priorities, the role of utility calculus in quantifying the ethical dilemmas that surround clinical trials, and the use of patient attitude towards outcomes of treatment as a covariate in its own right.     

临床药师在抗菌药物临床应用管理中的作用

目的探讨临床药师在抗菌药物临床应用管理中的作用。方法选取2015年1月—2016年6月住院治疗的120例发生感染的患者,随机分为对照组和观察组,每组60例。对照组采用常规抗生素治疗,无临床药师干预治疗,观察组在对照组的基础上加入临床药师的干预治疗,比较两组患者的抗菌效果、住院时间、恢复时间及不良反应发生率。计量资料采用t检验,计数资料采用χ~2检验,P0.05为差异有统计学意义。结果观察组的总有效率(90%)优于对照组(75%),差异具有统计学意义(P0.05);观察组患者的恢复时间(3.3±0.8)d、住院时间(12.8±1.5)d短于对照组患者的恢复时间(5.7±1.3)d、住院时间(15.5±1.8)d,比较差异均具有统计学意义(均P0.05);观察组患者的不良反应发生率(8.33%)与对照组(21.67%)比较,差异有统计学意义(P0.05)。结论临床药师在抗菌药物临床应用管理中发挥着较大作用,可以提高患者的治愈率,减少不良反应,故医院应完善相关政策,推动临床药师参与临床治疗,充分发挥临床药师在抗菌药物临床应用管理中的积极作用。     

N-of-1 clinical trials should be incorporated into clinical practice

N-of-1 clinical trials have the potential to contribute to individual patient management and to the accrual of important information about populations. Incorporating these studies into clinical practice will require creative thinking so as to maintain rigor without excessive disruption of routine care.     

医用中心雾化治疗系统的研发及临床应用

目的：设计一套对多人同时进行雾化治疗系统替代单人使用的雾化治疗器。方法：采用大型空气压缩机组将恒压并处理过的空气通过连接管路引入到雾化室内的多个设备带终端。患者将雾化药杯的管子接入设备终端就可进行雾化治疗。结果：该系统完全达到设计要求,能够同时对40~100人进行雾化治疗,疗效稳定可靠,治疗效率大幅提升。结论：该系统安全稳定、高效、可靠,适合在医院推广使用。     

Techniques for measuring clinical competence: objective structured clinical examinations

The traditional clinical examination has been shown to have serious limitations in terms of its validity and reliability. The OSCE provides some answers to these limitations and has become very popular. Many variants on the original OSCE format now exist and much research has been done on various aspects of their use. Issues to be addressed relate to organization matters and to the quality of the assessment. This paper focuses particularly on the latter with respect to ways of ensuring content validity and achieving acceptable levels of reliability. A particular concern has been the demonstrable need for long examinations if high levels of reliability are to be achieved. Strategies for reducing the practical difficulties this raises are discussed. Standard setting methods for use with OSCEs are described.     

紧密结合临床实际 做好临床科研工作

医疗工作是医院的核心工作。医院的医疗和科研水平是对一所医院和一名现代医生的重要评价指标。现实中,医院的临床工作和科研工作之间存在一些矛盾。医院和临床医生应从临床工作实际出发,注重临床科研选题的现实性,加强与基础医学的结合,促进科研成果向临床应用的转化,以有效的科研工作促进临床工作,最终提高临床医疗水平,推动人类医学进步。