Inverse probability weighting for covariate adjustment in randomized studies

Covariate adjustment in randomized clinical trials has the potential benefit of precision gain. It also has the potential pitfall of reduced objectivity as it opens the possibility of selecting a ‘favorable’ model that yields strong treatment benefit estimate. Although there is a large volume of statistical literature targeting on the first aspect, realistic solutions to enforce objective inference and improve precision are rare. As a typical randomized trial needs to accommodate many implementation issues beyond statistical considerations, maintaining the objectivity is at least as important as precision gain if not more, particularly from the perspective of the regulatory agencies. In this article, we propose a two‐stage estimation procedure based on inverse probability weighting to achieve better precision without compromising objectivity. The procedure is designed in a way such that the covariate adjustment is performed before seeing the outcome, effectively reducing the possibility of selecting a ‘favorable’ model that yields a strong intervention effect. Both theoretical and numerical properties of the estimation procedure are presented. Application of the proposed method to a real data example is presented. Copyright © 2013 John Wiley & Sons, Ltd.     

客观结构化考试在学生中医临床能力考核中的应用

目的对客观结构化临床考试在中医药高等专科学校各专业临床诊疗能力考核中应用的可行性进行探讨。方法设立以标准病人、模拟病人、模拟工具及电脑模拟等多种形式的系列考站，对在校中医临床、针灸推拿等专业临床各科课程结束的技能考核和实习前技能总考核采用客观结构化考试方法，初步观察并分析考核结果的信度与效度。结果客观结构化临床考试结果具有较高的信度和效度。结论中医客观结构化临床考试在评价学生中医诊疗临床能力方面具有标准化、客观化和结构化3大基本特点。     

论中药不良反应的客观真实性

中药不良反应是当今人们关注的热点问题之一,国外应对方法是颁布与之相关的中药的禁令,国内对如何正确应对中药不良反应没有制定一种切实可行的措施。因此,本研究在回顾性研究的基础上,选取国家在中药安全性评价中作为示范研究的千里光、青木香、大黄、益母草、附子、柴胡等具有代表性的中药,审视中药不良反应的客观真实性,进而维护中药的良好声誉,释除人们对中药安全性的担忧。     

On evidence, embellishment and efficacy

Evidence-based medicine (EBM) — to use a vogue word — is the contemporary mantra of many academic physicians. Unfortunately, the evidence they consider, although superficially convincing, is often slanted, occasionally deliberately, but more often as a result of carelessness and defects in study design. These biases and confounding factors are often hidden and arcane and seriously impair objective assessment. Such defects can only be detected when all investigators agree to go along with Bradford Hill's dictum, namely 'It is the essence of science to disclose both the data upon which a conclusion is based and the methods by which the conclusion is obtained'; a cardinal rule more often honoured in the breach than the observance.     

使用客观方法对142例湿热型肝癌患者进行舌象观察

Objective: To establish the diagnosis evidence of objective tongue inspection for liver cancer (LC) patients with damp-heat syndrome (DHS) by dynamically observing their tongue figures using modern tongue image analytic apparatus, and to explore the effect of intervention on the tongue figures. Methods: Tongue figures were collected from 142 LC patients with DHS by tongue image analytic apparatus. Red (R), green (G) and blue (B) values were analyzed. The r and g values were calculated requesting r=R/(R+G+B), g=G/(R+G+B), and b=1–r–g, and scored in combination with Chinese medical symptoms scale. The tongue figure and correlated scores were collected from 59 of them 3 days after transcatheter arterial chemoembolization intervention. Results: The range of objective tongue inspection of LC patients with DHS was as follows: as for tongue fur, 0.360Conclusion: The range of objective tongue inspection of LC patients with DHS could be known by collecting and analyzing objective indicator of tongue figures, thus laying foundation for further studies with analysis of correlation between intervention and Chinese medicine based on tongue figures.     

Medical science, nursing, and the future

Drawing on the work of Evelyn Fox Keller, this paper examines the notion of 'objectivism' and suggests that medicine as a science is premised upon the denial of common mortality. Alternative models for medicine are then examined, including the 'romantic science' of Oliver Sacks, and the paper concludes with a brief discussion of nursing as a key concept in the articulation of a more comprehensive medicine of the future.     

Establishing nurses' preferences in wound assessment: a concept evaluation

Aims and objectives. The aim of the study was to contribute to increasing reliability of wound assessment. The objectives were to capture terminology used and to assess whether these words reflected personality preferences for information. Background. Wound assessment forms are expected to be used reliably by non‐experts. This assumes that they mean the same thing to all practitioners. But many wound assessment forms are too complicated and do not necessarily show whether a wound is healing or not. Literature indicates that people have different information preferences that they use to aid judgement. Design. A correlational study investigating the relationship between word‐preferences and assessor's personality type. Method. Postregistration students (n = 45) and Tissue Viability Nurses (n = 16) suggested words or phrases to be used in an hypothetical wound assessment. Analysis was performed of how they preferred to describe healing, stasis and deterioration. They ranked the three most important signs they would look for in the three phases of wounds. Words were classified into categories (e.g. subjective, objective, value judgement), then matched with preferences seen in a personality type indicator. Results. Healing and deteriorating wounds were assessed relative to different signs or symptoms and static wounds were the most difficult to describe (mostly by absence of signs of healing). Personal types of approach to assessment could be identified: including subjectifiers and quantifiers. Conclusions. In this preliminary study, statistically significant results support the view that wound assessment involves assessor preferences. Assessors judge by the absence rather than the presence of some signs and symptoms. Relevance to clinical practice. Wound assessment forms need to take account of assessor preferences for subjectivity or quantification if reliability is to be increased, also different wound assessment forms could suit different wound phases. Potentially, assessor types could seek agreement more on outcomes of assessment rather than input.     

基于人体可获取诊断信息技术的集成中医诊疗设备的实现

以计算机技术、电子技术和通信技术为特征的现代信息技术的发展,促进了理工医之间的结合,各种获取人体诊断信息的设备不断出现,凸显了诊断医学的进步。随着现代科学技术的引入与结合,以中医理论为基础,拓展和延伸传统诊法的内涵,将各种可获取的人体诊断信息整合为基于主客观联合辨证的、以数据形式表达的中医四诊合参,获得更为全面的检测、识别与分类信息,对病证给出综合性判断,形成多信息融合的开放性中医诊疗平台。同时,将传感器网络技术与中医诊疗手段相结合,形成以中医诊疗为特色的嵌入式低成本、移动型医院、社区、家庭远程监护网络,实现中医诊疗器械的个人手持终端服务。在此基础上,建立中医远程医疗服务器系统,实现多中心信息的共享与中医远程诊断和远程复现。     

Learning Contracts

Social Work's commitment to the principles of self-determination and empowerment has proven difficult to operationalize. When learning contracts in field education utilize both positivist and interactionist theoretical frameworks, they facilitate student participation and empowerment in a manner consistent with adult learning priciples. As a result, students are better able to apply the concept of self-determiniation for the empowerment of clients and the profession. This paper examines the implications of both frameworks for learning contracts. The positivist tradition prevails in learning contracts; yet the interactional process is crucial to their effective use. Consequently, learning contracts are misunderstood and underutilized.     

中医舌诊的客观化研究

千百年来，中医舌诊只能凭医生肉眼观察，靠经验辨证，这不仅影响中医的继承，而且影响中医的提高和发展，因此迫切需要实现中医舌诊的标准化、客观化。随着中医现代化研究的进一步开展，以现代科学技术手段研究舌诊，使其定量化、客观化、标准化，已成为舌诊研究的主要方向。本研究以舌诊的计算机自动识别过程为主线，对舌诊客观化中涉及的舌象采集、舌象分割及舌象特征分析等技术进行了探讨。