Consensus on the use and monitoring of anti‐TNF‐α therapies for rheumatic diseases in Hong Kong 2005

The development and use of the tumour necrosis factor (TNF) antagonists is a major breakthrough in the treatment of many rheumatic diseases. Although these novel agents are undoubtedly superior to conventional therapeutic modalities, their costs and potential adverse effects are of concern. The current consensus statements were developed in early 2005 to help practicing rheumatologists identify which adult patients may benefit from anti‐TNF therapies and highlight their potential toxicities. The Hong Kong Society of Rheumatology has developed a registry on the use of the biologics in our local patients with chronic rheumatic disorders. Because the indications and novel data regarding the TNF inhibitors are ever changing, this consensus will be updated regularly.     

Patient satisfaction with and recommendation of a hospital: effects of interpersonal and technical aspects of hospital care.

OBJECTIVES: To examine patient satisfaction with and recommendation of a hospital, with a special focus on the correlation of these measures to patient ratings of interpersonal and technical performance of the hospital. DESIGN: Telephone survey of patients with four specific conditions after their discharge from hospitals. SETTING: Accredited district teaching hospitals and above, nationwide in Taiwan. PARTICIPANTS: A total of 4945 patients from 126 hospitals diagnosed with or undergoing procedures related to stroke, diabetes mellitus, Caesarean section, or appendectomy were interviewed by telephone. MAIN OUTCOME MEASURES: Overall patient satisfaction and recommendation were measured by single-item questions. Interpersonal skills were measured by three items: doctors' explanation, attitude, and caring. Technical skills were measured by another three items: hospital equipment, clinical competence, and outcome of treatment. RESULTS: Interpersonal skills were as influential or more influential than clinical competence on patient satisfaction for three of the four disease categories. In contrast, technical competence was a more influential predictor for recommendation for patients in all four disease categories. CONCLUSION: The preliminary results imply that a hospital with high percentage of patient satisfaction does not necessarily receive a high level of recommendation. This finding provides new insights for researchers and for hospital managers who devote resources exclusively for achieving the highest possible levels of patient satisfaction.     

我国贫困地区县域内健康扶贫工作进展与政策建议

通过健康扶贫政策梳理、定量分析卫生健康统计数据和典型案例分析,研究我国县域内健康扶贫工作的进展、成效及问题,提出后脱贫期县域内医疗卫生服务改革与发展的建议。整体上看,我国健康扶贫工作成效显著:医疗卫生机构"三个一"和医疗服务能力"三条线"目标基本实现;卫生技术人员配置基本达到"三个一"要求;贫困县床位和设备配置达到或接近全国平均水平;通过新建临床专科、开展新技术和新项目等,贫困县专科服务能力得到提升;此外,部分贫困地区积极探索县域内医疗卫生综合改革。今后,新脱贫地区面临的主要挑战是县域内卫生服务体系建设仍需加强,基层卫生人才队伍差距和财政投入与卫生改革协同不足三大主要问题。建议中央财政继续支持县域内卫生服务体系建设;以人才建设为抓手,提升县域内医疗服务能力;强化保障措施,推进县域内医疗卫生综合改革。     

药物气相色谱分析衍生化方法推荐专家系统的设计与实现

介绍了药物气相色谱分析衍生化方法推荐专家系统。该系统可对分子量小于５００,且分子中含有－ＣＯＯＨ、－ＣＯＯ－、－ＯＨ、－Ｏ＾－、－ＮＨ２（包括Ｒ－２、＝ＣＯＮＨ２、－ＳＯ２ＮＨ２）、ＮＨ（包括Ｒ１ＮＨＲ２、－ＣＯＮＨＲ、－ＣＯＮＨＳＯ２－、－ＳＯ２ＮＨＲ、Ｒ１ＮＨＣＯＮＨＲ２）、Ｒ４Ｎ（＋＋、Ｃ＝、＝ＣＨＯ、－ＳＨ、＝ＳＯ３Ｈ、－ＳＯ３＾－等 有团的药物实现衍生化方法推荐,并能自动调用柱系统推荐子     

制定肠外肠内营养指南和规范的"指南":方法学、推荐意见分级与通过程序

中华医学会肠外肠内营养学分会自2004年12月成立，即开始了合理规范应用肠外肠内营养学的有关工作。在中华医学会正副会长的指导下，2005年4月启动了肠外肠内营养“指南”和“规范”的制定工作。参与“指南”和“规范”编写的52位专家来自多个学科，也包括部分基层医院医护人员；共组成8个编写组，分别完成“指南”（草案）相应部分和部分“规范”的内容。 2006年5—8月，有7个编写组先后召开了8次总论和各论的“共识”和“规范”会议，就本版的编撰结构、证据分级和推荐意见分级体系、文献检索策略等方法学问题展开讨论，确定了工作方案，各自召开“共识会议”进行讨论，完成相应的文件。 通过确定检索策略、入选标准和特定关键词，采用系统化的文献检索，收集指南推荐意见相关支持证据。按照证据级别，参照国际标准并结合本领域的国内情况，制定推荐意见分级体系。 分会的“指南”（草案）和“规范”（草案）由各个“共识工作组”相互配合完成。达成“共识”后和最终定稿前，按“议事规则”对“指南”（草案）和“规范”（草案）进行投票表决。“肠外肠内营养临床指南和操作规范”力图反映目前国内外肠外肠内营养支持的最新证据，为临床医师、护理工作者、营养师和患者在特定临床条件下制定和实行肠外肠内营养支持方案提供帮助，并为卫生政策的制定者提供决策依据。由于内容宽广，部分内容欠缺甚多，有待今后补充。     

一种基于信任的Web服务工作流组织模型

跨组织工作流致力于跨越组织界限的业务重组,经过组织体间的网络行为的直接交互与间接推荐,从而形成松散藕合的工作流联盟。这种基于网络行为形成的联盟信任机制具有身份信任不可替代的作用。文章提出了一种基于网络行为的联盟信任模型,研究了D-S证据理论和冲突处理方法在工作流联盟信任模型中的应用。为了解决间接信任度的计算问题,对经验推荐路径的搜索进行了研究。利用这些理论来解决模型中信任的度量、传递和组合问题。结果分析表明,与已有的工作流联盟模型相比,提出的工作流联盟信任模型具有更细的可信实体粒度和更精确的组合信任度。模拟实验结果证实了工作流信任模型可有效提高联盟的稳定性,提高了工作流执行的成功率。     

Best Clinical Practice in Botulinum Toxin Treatment for Children with Cerebral Palsy

Botulinum toxin A (BoNT-A) is considered a safe and effective therapy for children with cerebral palsy (CP), especially in the hands of experienced injectors and for the majority of children. Recently, some risks have been noted for children with Gross Motor Classification Scale (GMFCS) of IV and the risks are substantial for level V. Recommendations for treatment with BoNT-A have been published since 1993, with continuous optimisation and development of new treatment concepts. This leads to modifications in the clinical decision making process, indications, injection techniques, assessments, and evaluations. This article summarises the state of the art of BoNT-A treatment in children with CP, based mainly on the literature and expert opinions by an international paediatric orthopaedic user group. BoNT-A is an important part of multimodal management, to support motor development and improve function when the targeted management of spasticity in specific muscle groups is clinically indicated. Individualised assessment and treatment are essential, and should be part of an integrated approach chosen to support the achievement of motor milestones. To this end, goals should be set for both the long term and for each injection cycle. The correct choice of target muscles is also important; not all spastic muscles need to be injected. A more focused approach needs to be established to improve function and motor development, and to prevent adverse compensations and contractures. Furthermore, the timeline of BoNT-A treatment extends from infancy to adulthood, and treatment should take into account the change in indications with age.