PREFERENCES FOR THE NORMATIVE BASIS OF HEALTH CARE PRIORITY SETTING: SOME EVIDENCE FROM TWO COUNTRIES

The present paper concerns the criteria people would prefer for prioritising health programmes. It differs from most empirical studies as subjects were not asked about their personal preferences for programmes per se. Rather, they were asked about the principles that should guide the choice of programmes. Four different principles were framed as arguments for alternative programmes. The results from population surveys in Australia and Norway suggest that people are least supportive of the principle that decision makers should follow the stated preferences of the public. Rather, respondents expressed more support for decisions based upon health maximisation, equality and urgency. Copyright © 2012 John Wiley & Sons, Ltd.     

Rosiglitazone maleate + metformin hydrochloride extend: review of an emerging compound

Clinical practice guidelines from around the world have continued to highlight the importance of glycemic control in the prevention of diabetes complications. Despite the many tools available to achieve these targets, it remains a constant challenge for healthcare providers and patients alike. Rosiglitazone maleate + metformin hydrochloride extend is a new compound that has the advantage of the clinical experience and knowledge about the current version and the added benefit of being a once daily, single pill option. The existing version of rosiglitazone + metformin has been shown to effectively lower hemoglobin A1C, improve insulin sensitivity and minimize weight gain. It is expected that the new compound will also have similar features, with the added benefit of improved patient adherence given its once daily formulation.     

基于置信规则库的慢性萎缩性胃炎陈永灿辨证经验挖掘

[目的] 根据名老中医陈永灿(下称陈氏)诊治慢性萎缩性胃炎(chronic atrophic gastritis，CAG)的临床资料和诊疗方案，挖掘基于置信规则库(belief rule base，BRB)的CAG辨证经验。[方法] 对症候信息进行编码，将症候“有、无”分别赋值为“1、0”，以此建立CAG中医症候信息数据库。将编码后的信息作为CAG辅助诊断模型的输入特征，通过BRB挖掘症候信息与证素之间的关系，利用证据推理(evidence reasoning，ER)融合算法对输入特征进行激活处理并输出结果，最后根据输出的证素结果结合临床实际得到证型。[结果] 在收集到的572例CAG病例数据集上对CAG辅助诊断模型进行训练及测试，证实该模型准确率达到79.07%，优于传统的支持向量机(support vector machine，SVM)算法；由预测结果得到的证型主要为脾虚气滞型、寒热错杂型、肝胃郁热型。[结论] CAG辅助诊断模型在实际临床运用中具有可行性，表明人工智能技术有助于名老中医经验的传承和传播。     

医疗失效模式与效应分析在药物基因实验质量管理的应用与实践

目的 通过应用医疗失效模式与效应分析(healthfailure mode and effect analysis，HFMEA)，预防药物基因实验的风险事件，提高药物基因实验的操作质量。方法 药学实验室成立失效模式与影响分析(failure mode and effect analysis，FMEA)活动小组，采用头脑风暴法，借助HFMEA模式，识别及分析药物基因实验过程前、中、后可能存在的操作、仪器及环境对药物基因实验质控造成的风险事件，同时制定相对应的解决方案。结果 开展HFMEA活动后，预防与补救了药物基因实验前、中、后的风险事件产生，风险系数值由总分值1 375分降至62.36分，降幅为95.47%(P<0.01)；活动小组成员在品管手法、解决问题能力、沟通配合、积极性等方面得到了显著提高。结论 HFMEA活动有助于降低药物基因实验产生风险事件的频次，有效提升实验室的质量管理。     

Opportunities for Improving Post-Hospital Home Medication Management Among Older Adults

SUMMARY

Effective post-hospital home medication management among older adults is a convoluted, error-prone process. Older adults, whose complex medication regimens are often changed at hospital discharge, are susceptible to medication-related problems (e.g., Adverse Drug Events or ADEs) as they resume responsibility for managing their medications at home. Human error theory frames the discussion of multi-faceted, interacting factors including care system functions, like discharge medication teaching that contribute to post-hospital ADEs. The taxonomy and causes of post-hospital ADEs and related risk factors are reviewed, as we describe in high-risk older adults a population that may benefit from targeted interventions. Potential solutions and future research possibilities highlight the importance of interdisciplinary teams, involvement of clinical pharmacists, use of transitional care models, and improved use of informational technologies.