医学生医学统计学教学方法的改革与初步实践简

目前医学生〈医学统计学〉的学习效果不是很理想,在发表的科研论文中,统计方法使用错误的现象也较为常见.为了提高医学专业学生的教学质量,培养学生对医学统计学的学习兴趣,提高他们使用统计软件自主处理医学数据的能力,为医学科研发展提供更加准确可靠的信息,有必要对医学生的医学统计学教学改革进行探讨并付诸于实践.     

提高人文医学执业技能构筑临床和谐医患关系

目的通过对临床医师的人文医学执业技能的分阶段培训，使医学科学精神和医学人文精神能够更好的协调发展，构筑临床和谐的医患关系。方法采用CMDA＆HumPRO项日研究模式对医院全体医师进行人文医学执业技能的分阶段培训。结果临床医生的沟通能力明显增强，同时得出患者告医生的最主要的五个因素和最能够降低患者投诉率的七个技能。结论良好的人文医学执业技能够增加医生与患者的沟通能力，并能构筑良好、和谐的医患关系，有利于提高医生的诊治能力。     

浅谈临床教学中学生临床思维能力的培养

临床思维是医生进行临床工作的心理基础,直接影响医生的临床诊治能力.临床思维培养是医学教学工作的重点.本文简要概述临床思维的内容和特点,并提出临床思维培养的方法和要点.     

医学统计学在基层综合性医院科研设计、学术论文中运用情况调查与分析

加强医学科研人员创新意识和创新能力的培养对提高医院服务水平有极为重要的意义.其中科研水平与学术论文是最为显著的标志,科研的设计、论文资料的描述、统计结果的解释和表述等都离不开医学统计学.医学统计学是根据概率论和数理统计的原理,研究医学数据收集、表达和分析的一门应用科学.误用或滥用统计学不仅不能提高论文的质量,反而会大大降低论文、科研的科学性.笔者通过问卷调查的方式,对临床医务人员应用医学统计学的情况进行了解,探讨临床医务人员对科研设计、统计学方法及科研论文写作的继续教育的需求及其对临床医疗水平的影响.     

安徽医科大学将举办2005年医学统计软件应用继续教育

近年来常用医学统计软件在医学科研和医学论文写作中发挥着越来越重要的作用，但很多撰写医学论文的作者，尤其是临床工作者由于缺乏医学统计学方面的继续教育，对医学统计学知识掌握不够，也很少了解和应用医学统计软件，影响了其科研水平和论文的质量。为了进一步普及医学统计软件基础知识，提高科研和论文水平，     

临床药学专业医学统计学教学模式实例分析

临床药学是连接医学和药学的新兴学科,医学统计学是医学中重要的基础课之一,该文采用实例分析探讨临床药学专业医学统计学的教学模式问题,分析临床药学与医学统计学的特点,结果表明实例分析教学有助于临床药学专业学生认清医学统计学的学科特点,培养学生解决实际问题的能力,提高教师的引导能力。实例分析是适应临床药学专业需求的教学模式。     

CHISS软件及其在医学统计教学中的应用

CHISS(奇思 )统计软件具有中国自主知识产权 ,其操作直观方便 ,统计功能较强大。我们应用CHISS统计软件进行医学统计学教学时 ,通过 18学时的现代统计学方法的学习及 6学时的CHISS上机后 ,对 135名医学博士进行CHISS软件使用问卷调查 ,结果发现CHISS能满足医学统计学教学和科研工作的需要 ,对CHISS软件满意率为 95 .93%。     

优化组合医学模拟教学及传统教学在临床教学中的应用

医学是一门经验性科学,临床教学任重而道远,临床实践教学是培养医学生的重要环节,其目的是对医学生进行临床思维、临床技能和实际临床工作能力的培养和训练,没有临床实践教学就不能培养出合格的医生,该文通过对医学模拟教学和传统教学在临床教学中优势和缺陷进行分析,发现将2种教学方法优化组合起来,更有利于提高学生的临床思维,判断能力,提高教学质量,培养合格的医学人才。     

电子表格软件Excel在常用医学统计学中的应用

对电子表格软件Excel提供的统计功能进行研究,探讨其在医学统计中常用的统计学数据处理上的应用.     

提高儿科临床带教质量的体会

目的 随着社会进步及医学发展,儿科带教医生必须转变带教观念,切实提高儿科临床带教质量,才能使医学生顺利完成儿科临床实习.方法 结合多年的临床带教工作实践,总结提高儿科临床带教质量的体会.结果 提高儿科临床带教质量,必须带教医生、医学生及管理机构共同配合,各司其职,主动参与才能完成好.结论 提高儿科临床带教质量要注意加强和完善儿科带教工作的管理;注意提高儿科带教医生的综合素质;加强医学生对儿科重要性的认识;严格要求,强化"三基"训练;采用多样化带教,培养医学生实际工作能力;注意临床带教工作中医疗纠纷的防范.     

Does bad inference drive out good?

The (mis)use of statistics in practice is widely debated, and a field where the debate is particularly active is medicine. Many scholars emphasize that a large proportion of published medical research contains statistical errors. It has been noted that top class journals like Nature Medicine and The New England Journal of Medicine publish a considerable proportion of papers that contain statistical errors and poorly document the application of statistical methods. This paper joins the debate on the (mis)use of statistics in the medical literature. Even though the validation process of a statistical result may be quite elusive, a careful assessment of underlying assumptions is central in medicine as well as in other fields where a statistical method is applied. Unfortunately, a careful assessment of underlying assumptions is missing in many papers, including those published in top class journals. In this paper, it is shown that nonparametric methods are good alternatives to parametric methods when the assumptions for the latter ones are not satisfied. A key point to solve the problem of the misuse of statistics in the medical literature is that all journals have their own statisticians to review the statistical method/analysis section in each submitted paper.     

某三甲医院超说明书用药问卷调查分析

目的：调查某三甲医院临床医师对超药品说明书用药行为的认知情况和专业管理需求,为促进临床合理用药提出相关建议。方法：对全院临床医师进行抽样问卷调查,将资料构成比作为指标进行描述,采用χ²检验进行统计分析。结果：本次发放问卷有效回收率为94.5%。临床医师职称越高,超说明书用药可能性越高;不同职称临床医师均认为自身药学知识储备不足,并希望行政主管部门发挥作用,约束超说明书用药行为。结论：超药品说明书用药行为与临床医师对其的认知情况有着直接的关系,超说明书用药情况普遍存在且不可避免,临床医师应当慎重考虑"超说明书用药",加强自身素养,与临床药师及相关行政管理部门全力配合,一方面保障患者用药安全,另一方面避免医疗风险。     

某市社区医务人员健康状况和体育锻炼的调查与分析

采用健康体检、问卷调查、数理统计等方法对社区医务人员进行健康状况调查和体育锻炼特征等调查。研究社区医务人员群体的健康现状与体育锻炼的特征。旨在为我国社区医务人员健康状况研究提供参考,也为全民健身提供依据。     

临床应用抗菌药物的干预措施及其效果分析

目的:探讨干预措施在抗菌药物临床应用中的有效性和可行性。方法:以随机抽样法抽取2008年住院病历1 224份和2009年住院病历1 893份进行统计分析。结果:抗菌药物使用率、联合用药、围术期预防用药等方面在干预前后的差异有统计学意义。结论:加强对抗菌药物临床应用的考核,将考核结果公示并与质控挂钩,对规范临床医生选择抗菌药物有一定作用。     

A survey of statistical methodology used in Ethiopian health science research journals

Results from many research efforts have been generated from the use of statistical methods. However, most researchers use data analysis as the only component of statistics to arrive at their results. There is a concern that this alone may not yield the appropriate result if it is not done with due understanding of and regard for study design, data acquisition techniques, choice of sample, and methods of statistical analysis. This paper attempts to document how much of these statistical methods are in use in Ethiopian health science research journals. All the original articles, in the two health science research journals--Ethiopian Medical Journal and The Ethiopian Journal of Health Development published between 1995 and 1999 were surveyed. A total of 232 papers were evaluated to see how far their authors have complied to these basic requirements as well as the statistical software used. The results of the survey demonstrate that in about 80% of the papers, the study design has been specified, 50% employed cross-sectional or survey designs, 14% provided detailed information on how sample size was determined and of this group 37% employed probabilistic selection methods. About 84% of the papers did not mention clearly what statistical methods they intended to employ to answer their research questions. Compared to others, attaching variability to a statistic using +/- SD or SE, t-statistics and P values were more frequently misused. Only 57% used computers to manage their data and do statistical analysis. EPI-INFO (a statistical software for Epidemiology) was used in 61% among the users of computer software. Considering the important roles of health science journals in guiding and updating good medical practice, low level and inappropriate use of statistical methodologies in the surveyed journals should give cause for concern. It is, therefore, recommended that a series of continuing education in statistics is done periodically to enhance the knowledge of health science researchers as well as editors and peer reviewers of health science journals to expand their background in statistical methods and acquaint them with new techniques.     

Statistical inference following sample size adjustment based on the 50%-conditional-power principle

Sample size adjustment at an interim analysis can mitigate the risk of failing to meet the study objective due to lower-than-expected treatment effect. Without modification to the conventional statistical methods, the type I error rate will be inflated, primarily caused by increasing sample size when the interim observed treatment effect is close to null or no treatment effect. Modifications to the conventional statistical methods, such as changing critical values or using weighted test statistics, have been proposed to address primarily such a scenario at the cost of flexibility or interpretability. In reality, increasing sample size when interim results indicate no or very small treatment effect could unnecessarily waste limited resource on an ineffective drug candidate. Such considerations lead to the recently increased interest in sample size adjustment based on promising interim results. The 50% conditional power principle allows sample size increase only when the unblinded interim results are promising or the conditional power is greater than 50%. The conventional unweighted test statistics and critical values can be used without inflation of type I error rate. In this paper, statistical inference following such a design is assessed. As shown in the numerical study, the bias of the conventional maximum likelihood estimate (MLE) and coverage error of its conventional confidence interval are generally small following sample size adjustment. We recommend use of conventional, MLE-based statistical inference when applying the 50% conditional power principle for sample size adjustment. In such a way, consistent statistics will be used in both hypothesis test and statistical inference.     

Pharmacology and statistics: recommendations to strengthen a productive partnership

Critical to the discovery, development and rational use of drugs and vaccines are the foundational principles and proper application of statistics. However, in too many cases, there has been misuse of statistics and/or overemphasis on statistical significance (p < 0.05), as though this criterion possessed truth-guaranteeing properties. To clarify confusion about the proper use of statistics in pharmacology, we summarize briefly the foundational principles of probability; the role of statistics in assessment of causality; the three basic uses of statistical methods, especially those employed in hypothesis testing; and current statistical issues in pharmacological research. We then review and provide examples of the meaning of statistical significance, the consequences of lack of randomization in epidemiology/observation studies, the criteria for measurement instrument validation, the problems with subgroup analyses, the need for multiple comparison statistical methods, and how to handle dropouts and missing data. Finally, based on sound experimental and statistical principles, we make a series of recommendations to both experimentalists and journal editors to improve published pharmacological experiments. These include widespread use of blinding and randomization and/or random selection of subjects in both basic and clinical pharmacology, mandatory use of rigorous evidentiary criteria in epidemiology/observation studies claiming causal associations, proper interpretation of statistical versus clinical/pharmacological significance, appropriate interpretation of meta-analyses, meaningful validation of methods, and a more rational statistical approach to subgroup analyses and genetic association studies.     

药物统计学本科课程的教学研讨

药物统计学是统计学的一门应用分支学科,也是数学和药学相结合的交叉学科,正在药学研究中发挥越来越重要的作用。该学科的高校教学及人才培养是学界和教育界的研讨热点问题,但具体方案报道不多。安徽医科大学药学院从2005年始开设药物统计学本科课程,该文总结了近年来本单位在该学科教学方面的一些心得体会,并对相关教学问题进行了深入探讨。     

8772份终末质控病案缺陷分析及对策

目的分析我院2008年出院病案存在的缺陷,探讨提高病案质量的有效方法及规范化管理的措施。方法按照《广东省病历书规范》的具体要求,对2008年8772份出院病案进行终末质量控制,利用Spss16.0统计学软件对缺陷情况进行统计、归类、分析。结果终末质控病案8872份,缺陷病历1255份（14.31%）,缺陷项目1409项（1.12项/每份）。病案缺陷前三位构成依次为病案首页（28.32%）、病情记录（17.03%）、入院记录（12.21%）。结论应建立病案三级质量控制体系,强化病案书写培训,充分发挥信息反馈与奖惩机制作用,提高病历书写质量,防止医疗纠纷的产生。     

关于儿童药物剂量计算中的几个问题

目的:探讨儿童药物剂量计算的方式方法。方法:查阅大量的儿童专用药品说明书,调查、统计其中药物剂量的计算情况,并就有关问题进行探讨。结果与结论:目前儿童药物剂量的计算存在不规范之处,在儿童的年龄、年龄段的划分上缺乏统一的标准,迫切需要建立一个规范、统一的儿童药物剂量标准。