制定相关指标全面评价医院经济效益的方法初探

我院于1999年12月开展成本核算工作，运用经济手段加强医院管理。但成本核算只是医院经济管理手段之一，不能全面反映医院整体经济情况。为此，我们制订了相关经济效益评价指标，力求对医院整体经济效益进行分析，并对，如何准确评价医院经济效益作一探讨。     

Contesting the science/ethics distinction in the review of clinical research

Recent policy in relation to clinical research proposals in the UK has distinguished between two types of review: scientific and ethical. This distinction has been formally enshrined in the recent changes to research ethics committee (REC) structure and operating procedures, introduced as the UK response to the EU Directive on clinical trials. Recent reviews and recommendations have confirmed the place of the distinction and the separate review processes. However, serious reservations can be mounted about the science/ethics distinction and the policy of separate review that has been built upon it. We argue here that, first, the science/ethics distinction is incoherent, and, second, that RECs should not only be permitted to consider a study's science, but that they have an obligation do so.     

Human benefits of animal interventions for zoonosis control

Although industrialized countries have been able to contain recent outbreaks of zoonotic diseases, many resource-limited and transitioning countries have not been able to react adequately. The key for controlling zoonoses such as rabies, echinococcosis, and brucellosis is to focus on the animal reservoir. In this respect, ministries of health question whether the public health sector really benefits from interventions for livestock. Cross-sectoral assessments of interventions such as mass vaccination for brucellosis in Mongolia or vaccination of dogs for rabies in Chad consider human and animal health sectors from a societal economic perspective. Combining the total societal benefits, the intervention in the animal sector saves money and provides the economic argument, which opens new approaches for the control of zoonoses in resource-limited countries through contributions from multiple sectors.     

四甲基偶氮唑盐体外药物敏感试验联合多药耐药基因1检测预测非小细胞肺癌的化疗敏感性

目的评价四甲基偶氮唑盐(MTT)药物敏感试验联合多药耐药基因1(MDR1)检测预测原发性非小细胞肺癌(NSCLC)的化疗敏感性,为临床个体化治疗提供依据。方法选择淄博市中心医院2009～2011年手术切除的80例NSCLC患者[男46例,女34例;中位年龄54(29～81)岁]的新鲜标本,采用MTT药物敏感试验检测患者对顺铂(DDP)、吉西他滨(GEM)、多西紫杉醇(DOC)、依托泊苷(VP-16)及长春瑞滨(NVB)的体外药物敏感性,采用实时荧光定量逆转录-聚合酶链反应(RT-PCR)技术检测肿瘤组织MDR1表达水平。结果经化疗药物作用后,体外培养的NSCLC细胞出现不同程度的形态学改变、代谢活性下降及凋亡。MTT法检测结果提示,不同个体NSCLC细胞对不同化疗药物的敏感性不同,NSCLC细胞对不同化疗药物敏感性亦不同:对DOC、GEM及VP-16的敏感性高于DDP和NVB(42.5%±9.5%、40.5%±6.5%、38.4%±7.6%vs.31.5%±8.5%、32.5%±7.8%,P<0.05)。肿瘤组织中MDR1的阳性表达率为40.0%(32/80),MDR1阳性表达与患者肿瘤组织学类型、分化程度、淋巴结转移情况及TNM分期无关(P>0.05)。MDR1阳性表达与NVB(χ2=5.209,P=0.022)、GEM(χ2=4.769,P=0.029)、VP-16(χ2=4.596,P=0.032)及DDP(χ2=6.086,P=0.014)的体外耐药相关,而与DOC的体外耐药不相关(χ2=0.430,P=0.512)。结论 MTT药物敏感试验可有效预测临床化疗药物敏感性,MTT药物敏感试验联合MDR1检测可提高预测NSCLC化疗敏感性,指导其个体化治疗。     

Psychological,Social, and Environmental Factors Associated With Utilization of Senior Centers Among Older Adults in Korea

Objectives

The purpose of the study was to examine the relationships among the psychological, social, and environmental factors influencing the utilization of senior centers among older adults in Korea.

Methods

A questionnaire survey was administered to two types of older adults who lived in Seoul, Korea: 262 older adults who used senior centers (3 places) and 156 older adults who did not use senior centers.

Results

Our results showed clearly that the utilization of the senior centers in Korea is affected by higher self-efficacy (odds ratio [OR], 6.08; 95% confidence interval [CI], 3.31 to 12.32), higher perceived benefits (OR, 1.71; 95% CI, 1.16 to 4.36), lower perceived barriers (OR, 6.43; 95% CI, 3.07 to 11.45), higher family support (OR, 4.21; 95% CI, 2.02 to 8.77), and higher support from friends (OR, 4.08; 95% CI, 2.38 to 7.81). The results also showed that participants whose total travel time was 15 to 29 minutes (OR, 2.84; 95% CI, 1.21 to 3.64) or less than 14 minutes (OR, 4.68; 95% CI, 3.41 to 8.41) were more likely to use a senior center than those who had to travel more than 30 minutes.

Conclusions

This study showed that the utilization of senior centers in Korea is affected by psychological, social, and environmental factors, specifically by self-efficacy, perceived benefits, perceived barriers, social support, convenience of transportation, and total travel time to the senior centers. The effects of longer-term utilization of the senior centers by non-users on health-related outcomes in a large population warrant attention.