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1.
约1/4的难治性颞叶癫痫患者的发作无法通过常规前颞叶切除术得到有效控制,这可能是因为疾病存在多种复杂的亚型,且部分亚型涉及颞叶外的脑区病变。基于多模态脑影像特征,使用隐含狄利克雷分布模型可以估计潜在疾病因子及各因子在患者大脑内的表达程度,有助于个体精准分型。该研究通过PET/MR同步一体扫描仪采集了86名难治性颞叶癫痫患者的T1加权影像和FDG PET影像,并采集了39名健康志愿者的T1加权影像和36名健康志愿者的FDG PET影像作为对照。该研究提取与癫痫病理相关的灰质体积和葡萄糖摄取值,使用隐含狄利克雷分布进行分型,将疾病因子的数量分别设为3、4、5,进行多次实验,并对四因子模型中的各疾病因子与临床指标之间的关系进行统计分析。研究发现,选取不同数量的疾病因子进行分型时得到的结果具有一定的相似性。在四因子模型中存在与病灶偏侧性、癫痫发作年限和认知能力显著相关(P<0.05)的疾病因子。该研究对颞叶癫痫分型具有一定的参考价值。  相似文献   
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目的 分析2015—2020年重庆市各区县卫生资源配置效率,为重庆市提升资源配置效率提供参考。方法 采用数据包络分析的BCC模型和Malmquist指数对2015—2020年重庆市各区县卫生资源配置效率进行分析。结果 在2020年,重庆市卫生资源配置的综合效率不高,38个区县中有7个区县处于DEA有效状态,8个区县处于DEA弱有效状态;2015—2020年,重庆市全要素生产率指数均值为0.945,3个区县的全要素生产率指数大于1。结论 重庆市各区县卫生资源配置效率有待提高,重点在于提升技术进步水平;重庆市四大区域内部和四大区域之间卫生资源配置效率差异较大,需整合医疗卫生资源,重视医学科技创新和成果转化,达到提升卫生资源配置效率的目标。  相似文献   
3.
IntroductionLong-term care (LTC) is organized in a fragmented manner. Payer agencies (PA) receive LTC funds from the agency collecting funds, and commission services. Yet, distributional equity (DE) across PAs, a precondition to geographical equity of access to LTC, has received limited attention. We conceptualize that LTC systems promote DE when they are designed to set eligibility criteria nationally (vs. locally); and to distribute funds among PAs based on needs-formula (vs. past-budgets or government decisions).ObjectivesThis cross-country study highlights to what extent different LTC systems are designed to promote DE across PAs, and the parameters used in allocation formulae.MethodsQualitative data were collected through a questionnaire filled by experts from 17 OECD countries.Results11 out of 25 LTC systems analyzed, fully meet DE as we defined. 5 systems which give high autonomy to PAs have designs with low levels of DE; while nine systems partially promote DE. Allocation formulae vary in their complexity as some systems use simple demographic parameters while others apply socio-economic status, disability, and LTC cost variations.Discussion and conclusionsA minority of LTC systems fully meet DE, which is only one of the criteria in allocation of LTC resources. Some systems prefer local priority-setting and governance over DE. Countries that value DE should harmonize the eligibility criteria at the national level and allocate funds according to needs across regions.  相似文献   
4.
ObjectivesAdverse drug reactions (ADRs) are believed to be a leading cause of death in the world. Pharmacovigilance systems are aimed at early detection of ADRs. With the popularity of social media, Web forums and discussion boards become important sources of data for consumers to share their drug use experience, as a result may provide useful information on drugs and their adverse reactions. In this study, we propose an automated ADR related posts filtering mechanism using text classification methods. In real-life settings, ADR related messages are highly distributed in social media, while non-ADR related messages are unspecific and topically diverse. It is expensive to manually label a large amount of ADR related messages (positive examples) and non-ADR related messages (negative examples) to train classification systems. To mitigate this challenge, we examine the use of a partially supervised learning classification method to automate the process.MethodsWe propose a novel pharmacovigilance system leveraging a Latent Dirichlet Allocation modeling module and a partially supervised classification approach. We select drugs with more than 500 threads of discussion, and collect all the original posts and comments of these drugs using an automatic Web spidering program as the text corpus. Various classifiers were trained by varying the number of positive examples and the number of topics. The trained classifiers were applied to 3000 posts published over 60 days. Top-ranked posts from each classifier were pooled and the resulting set of 300 posts was reviewed by a domain expert to evaluate the classifiers.ResultsCompare to the alternative approaches using supervised learning methods and three general purpose partially supervised learning methods, our approach performs significantly better in terms of precision, recall, and the F measure (the harmonic mean of precision and recall), based on a computational experiment using online discussion threads from Medhelp.ConclusionsOur design provides satisfactory performance in identifying ADR related posts for post-marketing drug surveillance. The overall design of our system also points out a potentially fruitful direction for building other early warning systems that need to filter big data from social media networks.  相似文献   
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卫生资源优先次序分配作为政府有效治理的重要领域,在我国仍缺乏类似层面的综合思考。西方在该领域的研究趋势已从单纯的经济学思考走向了政治经济学、制度约束、卫生筹资的全面分析,并在更宏大的组织和政治情境中,考量政府的治理范围、手段,建构操作性强的优先次序分配框架。在卫生决策实践中,找寻跨学科工具的最佳组合考验着决策者的治理水平。本文梳理政治学、卫生经济学、哲学、法学、循证医学等不同学科对卫生资源优先次序分配的思考。最后明确政府卫生资源治理的层次、治理策略建议,强调卫生决策从"作为结构的治理"走向"作为过程的治理"的发展规律因应我国所面临的挑战。  相似文献   
7.
摘 要 目的:为检验机构和政府管理部门提供参考,旨在适应全面深化改革新形势,合理配置、科学管理和使用仪器设备,提高仪器设备使用效能,最大限度发挥仪器设备购买资金的经济和社会效益,有效服务监管、助推产业发展。方法: 结合药品、食品、化妆品、医疗器械(“三品一械”)检验机构面临的新形势,通过实地调研,分析“三品一械”检验机构在仪器设备配置、使用与管理方面存在的问题,针对问题提出对策及建议。结果: 部分“三品一械”检验机构的仪器设备配置、使用与管理存在诸多问题。结论: 应从明确采购需求、合理配置仪器、重视质量验收、完善管理制度、加强人员培训、大型设备共享及拓展检验机构职能等多个方面加以解决。  相似文献   
8.
While kidney paired donation (KPD) enables the utilization of living donor kidneys from healthy and willing donors incompatible with their intended recipients, the strategy poses complex challenges that have limited its adoption in United States and Canada. A consensus conference was convened March 29–30, 2012 to address the dynamic challenges and complexities of KPD that inhibit optimal implementation. Stakeholders considered donor evaluation and care, histocompatibility testing, allocation algorithms, financing, geographic challenges and implementation strategies with the goal to safely maximize KPD at every transplant center. Best practices, knowledge gaps and research goals were identified and summarized in this document.  相似文献   
9.
Severe geographic disparities exist in liver transplantation; for patients with comparable disease severity, 90‐day transplant rates range from 18% to 86% and death rates range from 14% to 82% across donation service areas (DSAs). Broader sharing has been proposed to resolve geographic inequity; however, we hypothesized that the efficacy of broader sharing depends on the geographic partitions used. To determine the potential impact of redistricting on geographic disparity in disease severity at transplantation, we combined existing DSAs into novel regions using mathematical redistricting optimization. Optimized maps and current maps were evaluated using the Liver Simulated Allocation Model. Primary analysis was based on 6700 deceased donors, 28 063 liver transplant candidates, and 242 727 Model of End‐Stage Liver Disease (MELD) changes in 2010. Fully regional sharing within the current regional map would paradoxically worsen geographic disparity (variance in MELD at transplantation increases from 11.2 to 13.5, p = 0.021), although it would decrease waitlist deaths (from 1368 to 1329, p = 0.002). In contrast, regional sharing within an optimized map would significantly reduce geographic disparity (to 7.0, p = 0.002) while achieving a larger decrease in waitlist deaths (to 1307, p = 0.002). Redistricting optimization, but not broader sharing alone, would reduce geographic disparity in allocation of livers for transplant across the United States.  相似文献   
10.
在建设中原经济区的现实背景下完善制度设计以实现健康公正是河南省医疗卫生体制改革的价值诉求.河南省探索医疗改革面临卫生资源配置悬殊、地域发展不平衡、城乡医疗鸿沟扩大等公正隐忧.实现河南省健康公正的建议:强化政府责任、完善医疗保障制度、秉承医学人文理念、关注弱势群体的生存环境.  相似文献   
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