浅谈产科病房的特色设计

在产科病房的设计上,采用一些温馨的主题化设计,既是医疗机构对"产妇"这一特殊群体的人文关怀,也是在国内大量VIP产科房间兴起的情况下差异化竞争的手段之一。文章通过上海仁济医院浦东分院VIP产科病房采用主题化的设计实例,从公共区域的设计、病房设计、配餐室设计等方面,阐述了产科病房特色设计的方法。     

Empirical investigation of experimental design properties of discrete choice experiments in health care

Experimental design is critical to valid inference from the results of discrete choice experiments (DCEs). In health economics, DCEs have placed limited emphasis on experimental design, typically employing relatively small fractional factorial designs, which allow only strictly linear additive utility functions to be estimated. The extensive literature on optimal experimental design outside health economics has proposed potentially desirable design properties, such as orthogonality, utility balance and level balance. However, there are trade-offs between these properties and emphasis on some properties may increase the random variability in responses, potentially biasing parameter estimates.This study investigates empirically the design properties of DCEs, in particular, the optimal method of combining alternatives in the choice set. The study involves a forced choice between two alternatives (treatment and non-treatment for a hypothetical health care condition), each with three, four-level, alternative-specific attributes. Three experimental design approaches are investigated: a standard six-attribute, orthogonal main effects design; a design that combines alternatives to achieve utility balance, ensuring no alternatives are dominated; and a design that combines alternatives randomly. The different experimental designs did not impact on the underlying parameter estimates, but imposing utility balance increases the random variability of responses.     

An overview of variance inflation factors for sample-size calculation

For power and sample-size calculations, most practicing researchers rely on power and sample-size software programs to design their studies. There are many factors that affect the statistical power that, in many situations, go beyond the coverage of commercial software programs. Factors commonly known as design effects influence statistical power by inflating the variance of the test statistics. The authors quantify how these factors affect the variances so that researchers can adjust the statistical power or sample size accordingly. The authors review design effects for factorial design, crossover design, cluster randomization, unequal sample-size design, multiarm design, logistic regression, Cox regression, and the linear mixed model, as well as missing data in various designs. To design a study, researchers can apply these design effects, also known as variance inflation factors to adjust the power or sample size calculated from a two-group parallel design using standard formulas and software.     

医疗设备维护管理信息支持子系统模式设计

医院信息化是提升医院管理水平的重要手段。随着医疗设备的增多,设备维护管理信息化成为医院信息化的一个新环节。为提高医疗设备管理的现代化、科学化和规范化水平,提出了医疗设备维护管理信息支持子系统的设计方案,较为详细地分析了维护管理信息支持子系统的设计意义、系统分析、设计架构和设计功能。     

A generalizability study of the Norwegian version of KINDL<Superscript>R</Superscript> in a sample of healthy adolescents

Purpose The aim in the present study was to illustrate generalizability theory by exploring some psychometric aspects of the Norwegian version of KINDL^R (KINDL-N). This questionnaire is a measure of quality of life in adolescents. It consists of 24 items arranged in six subscales or aspects, corresponding to six domains of adolescents’ health-related quality of life. Method A total of 239 healthy adolescents completed the questionnaire. The analysis was performed in line with generalization theory, and this analysis yields among other things so-called generalizability and dependability coefficients, which are analogous to reliability coefficients in classical test theory. The preferred design was a mixed two-facet design, with the six aspects as a fixed facet and the items nested within aspects as a random facet. For comparison, a random two-facet design and a one-facet design were also analyzed. Results The generalizability and dependability coefficients for KINDL-N are satisfactory, but the coefficients can be markedly improved by increasing the length of the instrument while keeping it to a manageable size. The mixed two-facet design resulted in somewhat higher coefficients than a one-facet design and much higher coefficients than a random two-facet design. Conclusion If the items within a questionnaire are arranged in distinct subscales, a two-facet design analyzed by generalizability theory gives more sophisticated results than classical test theory. Moreover, the results may depend considerably on whether a mixed or random two-facet design is chosen. Hence, the choice of an appropriate measurement design in line with the intended use of the questionnaire is essential.     

Analysis of case-cohort designs

The case-cohort design is most useful in analyzing time to failure in a large cohort in which failure is rare. Covariate information is collected from all failures and a representative sample of censored observations. Sampling is done without respect to time or disease status, and, therefore, the design is more flexible than a nested case-control design. Despite the efficiency of the methods, case-cohort designs are not often used because of perceived analytic complexity. In this article, we illustrate computation of a simple variance estimator and discuss model fitting techniques in SAS. Three different weighting methods are considered. Model fitting is demonstrated in an occupational exposure study of nickel refinery workers. The design is compared to a nested case-control design with respect to analysis and efficiency in a small simulation. In this example, case-cohort sampling from the full cohort was more efficient than using a comparable nested case-control design.     

Members of research ethics committees accepted a modification of the randomized consent design

BACKGROUND AND OBJECTIVE: The use of randomized consent designs has been subject of methodologic and ethical controversy. In most Western countries, research ethics committees make the decision as to whether a randomized consent design can be applied. The purpose of the study is to assess to what extent a randomized consent design and a modification of this design is accepted by research ethics committees, in terms of ethics, health law, and methodology. METHODS: A postal survey was conducted among members of research ethics committees in the United Kingdom, and in The Netherlands, with professional competence in ethics, (health) law, methodology, or clinical practice. RESULTS: In both the UK and in The Netherlands, the modified randomized consent design appears to be statistically significantly more acceptable than the randomized consent design, with respect to ethical and judicial aspects. The overall rejection rate of the randomized consent design was 66% in the UK and 59% in The Netherlands. However, the modified randomized consent design was rejected by 47 and 41% in the two countries, respectively. CONCLUSION: the modified randomized consent design appears to be more acceptable than the randomized consent design. To increase consistency in the way research ethics committees handle study protocols, a discussion about the use of randomized consent designs appears necessary.     

同水平析因设计矩阵的分解结果及其特点

目的介绍同水平析因设计矩阵的分解方法、分解结果及其特点,为多因素试验设计提供一种有效方法.方法以n水平(n≥3)的同水平多因素析因设计矩阵为基本的设计矩阵,不增加任何限定条件,仅考察各试验点对其余试验点的影响,采用"主成分分析、聚类分析和规则归纳"等数据挖掘技术相结合的方法,可将此矩阵分解成一系列彼此互不重叠的独立设计矩阵.结果独立设计矩阵具有一些很好的特点,有些本身就是正交设计,有些本身就是均匀设计,还有些是它们所不包含的特殊设计,这些设计一般都是比较理想的多因素试验设计.结论独立设计不仅涵盖了多因素析因设计、分式析因设计、正交设计、均匀设计,还有一些是具有实用性的特殊设计,它是一类具有很高理论研究价值和实际应用前景的综合性极强的多因素试验设计方法.     

中文科技期刊封面设计与探索——以《协和医学杂志》为例

【目的】 探索中文科技期刊封面发展的可行途径。【方法】 分析我国科技期刊封面设计现状以及制约中文科技期刊封面发展的瓶颈,并以《协和医学杂志》为例,介绍其封面设计团队的建立和运营经验,展示封面设计在其期刊品牌建设中发挥的作用。【结果】 中文科技期刊在编委人才梯队化建设过程中,通过主动发现和利用青年人才,能够建立稳定的封面设计团队,呈现高水平的封面设计,进而显著提升期刊品牌影响力。【结论】 封面质量建设对提升期刊品牌影响力具有重要作用,紧密结合中文期刊自身发展特点,善于借助可利用的优势资源,是中文科技期刊突破封面发展瓶颈的可行途径。     

人机工程在医疗器械设计中的应用

目前医疗器械产品的科技含量在不断提高,但在人机工程设计这一方面的重视程度依然不够.本文主要讲述了医疗器械人机工程学的概念、设计原则和内容.分析了医疗器械产品中人的因素特点、设备的安全性、医疗器械的使用环境等特点,提出了医疗器械产品设计应"以人为中心"的设计过程的理念.从医疗器械的人机界面方面进行了分析研究,提出了医疗器械具有双重人机界面的观点并对人机界面进行了分析研究.通过对对医疗器械的造型设计、色彩设计、触角设计、作业空间设计以及材质选择进行分析,阐述了医疗器械设计的选用原则,最后对医疗器械的人机工程发展趋势进行分析.人机工程在医疗器械设计中起着越来越重要的地位,对医疗器械产品设计的发展方向具有重要的指导意义.     

医院门诊药房服务系统设计研究

医院门诊药房服务系统的设计对于提高服务质量、增强医院核心竞争力具有重要意义。作者从医院门诊药房服务的特点出发，研究了门诊药房服务设计的思想，并介绍了服务设计技术方法在门诊药房中的应用，其主要是质量功能展开法在系统服务质量设计中的应用；计算机仿真技术在系统服务能力设计上的应用；业务流程再造理论在系统服务流程再造中的应用。     

传统艺术在健康教育海报设计的运用

中国传统艺术中的设计元素及其观点,深深地影响着现代健康教育的海报设计思想,而后者反过来又影响着传统民族艺术。本文论述了在现代健康教育海报设计中,各种表现手法的运用及其表现内容的体现,指出作为外来的海报艺术,在设计者的作品中,既流露出传统美学观点潜移默化的影响,也有现代设计理念、现代设计元素的补充。分析这些内容,肯定某些积极的因素,将会对我国卫生艺术设计及卫生事业的发展产生积极的影响。     

Stepwise Design and Evaluation of a Values-Oriented Ambient Intelligence Healthcare Monitoring Platform

ObjectivesThe majority of all developed digital health technologies do not reach successful implementation. A discrepancy among technology design, the context of use, and user needs and values is identified as the main reason for this failure. Value-sensitive design (VSD) is a design method enabling to align design with user values by embedding values in technology, yet the method is lacking clear heuristics for practical application. To improve the successful design and implementation of digital health, we propose and evaluate a stepwise approach to VSD.MethodsThe approach consists of the phases: experiment, demonstrate, and validate. Experiment takes place in an office to create makeshift solutions. Demonstrate takes place in a mock-up environment and aims to optimize design requirements through user feedback. The validate phase takes place in an authentic care situation and studies how the novel technology affects current workflows.ResultsWe applied the stepwise VSD approach to the design of a hospital-based ambient intelligence solution for remotely and continuously monitoring quality and safety of patient care. We particularly focused on embodiment of the values of safety, privacy, and inclusiveness in the design. Design activities of the experiment and demonstrate phase are discussed.ConclusionsA stepwise approach to VSD enables a design to optimally meet the values of all users involved, while aligning the design process with the practical limitations of healthcare institutions. We discuss some benefits and challenges related to VSD and the potential for transfer of this approach to other digital health solutions.     

阶梯设计在随机对照试验中的应用

介绍阶梯设计的基本原理和实施方法,探讨其在随机对照试验中的应用.当研究者希望在一定范围内全面推行某项通常来说"利大于弊"的措施,又想通过随机对照试验来对该措施的效果进行评价,尤其是当资源有限使得本来就只能分步实施干预的时候,阶梯设计非常适用.另外,该方法还可用来发现或控制时间趋势对效果评价的影响.但与传统设计相比,阶梯设计的试验周期更长,统计学问题也要复杂得多.因此,在设计和实施的过程中应严格把握有关注意事项,以保证研究结果的稳健性.     

Stopping clinical trials because of treatment ineffectiveness: a comparison of a futility design with a method of stochastic curtailment

This paper introduces a simple futility design that allows a comparative clinical trial to be stopped due to lack of effect at any of a series of planned interim analyses. Stopping due to apparent benefit is not permitted. The design is for use when any positive claim should be based on the maximum sample size, for example to allow subgroup analyses or the evaluation of safety or secondary efficacy responses. A final frequentist analysis can be performed that is valid for the type of design employed. Here the design is described and its properties are presented. Its advantages and disadvantages relative to the use of stochastic curtailment are discussed.     

Repeatability of a checklist for evaluating cab design characteristics of heavy mobile equipment

Risk factors associated with the development of musculoskeletal discomfort and disorders during the operation of heavy mobile equipment include whole-body vibration and awkward and sustained joint postures of the shoulders, neck, and trunk. Cab design may influence awkward postures of the joints, and task duration may influence duration of exposure to awkward and static postures and whole-body vibration. To reduce exposure to risk factors related to the interface between cab design and task, it may be necessary for manufacturers to address cab design. This study assessed the repeatability of a cab design checklist developed to evaluate various design characteristics that can influence exposure to risk factors for musculoskeletal discomfort. The ability of the cab design checklist to identify posture-related deficiencies of design was also assessed. The checklist was used by two administrators across 10 pieces of heavy construction equipment. Video analysis was performed to quantify postures of the neck, shoulder, and trunk; correlation analysis was used to determine whether specific questions from the checklist were associated with the identification of awkward postures. The repeatability assessment resulted in kappa coefficients ranging from 0.52 to 1.0 (good-to-excellent reproducibility) across each piece of equipment, and an overall kappa coefficient of 0.77 (excellent reproducibility) when considering all equipment together. Results from the correlation analysis showed that shoulder flexion posture was correlated with scores from the cab design checklist. However, results of the cab design checklist were not significantly correlated with shoulder abduction or awkward postures of the neck and trunk. Results suggest that the cab design checklist may be useful for identifying cab design characteristics that need further improvement and for identifying design characteristics that increase shoulder flexion. The strength of the repeatability assessment suggests that outcomes of the cab design checklist administered by different individuals may be consistent, independent of the type of equipment being assessed.     

Contribution of case-crossover design to the analysis of short-term health effects of air pollution: reanalysis of air pollution and health data

BACKGROUND: During the last decades, numerous studies have shown significant links between short-term exposure to air pollution and health. Time series design have been widely used in order to study these associations. In recent years, the case-crossover design has been applied to the analysis of acute effects of environmental exposures, especially air pollution. The aims of this paper are to describe the case-crossover design and to compare this approach with time series design to assess the association between air pollution and health. METHODS: In the case-crossover approach, a case-control study is conducted whereby each person who had a health event (case period) is matched with himself/herself on a nearby time period where he/she did not have the event (control period). Review of the literature shows that the referent selection strategies can be associated to a bias in the estimation of the health effect of air pollution. In comparison with time series design, the case-crossover design is easier to conduct, and individual factors can be taken into account. Nevertheless, it is not possible to take into account the overdispersion in the health indicator with this approach. RESULTS AND CONCLUSION: In conclusion, we suggest to use time series analysis with population data and case-crossover design with individual data.     

Statistical issues in the design and analysis of expertise-based randomized clinical trials

In order to avoid certain difficulties with the conventional randomized clinical trial design, the expertise-based design has been proposed as an alternative. In the expertise-based design, patients are randomized to clinicians (e.g. surgeons), who then treat all their patients with their preferred intervention. This design recognizes individual clinical preferences and so may reduce the rates of procedural crossovers compared with the conventional design. It may also facilitate recruitment of clinicians, because they are always allowed to deliver their therapy of choice, a feature that may also be attractive to patients.The expertise-based design avoids the possibility of so-called differential expertise bias. If a standard treatment is generally more familiar to clinicians than a new experimental treatment, then in the conventional design, more patients randomized to the standard treatment will have an expert clinician, compared with patients randomized to the experimental treatment. If expertise affects the study outcome, then a biased comparison of the treatment groups will occur.We examined the relative efficiency of estimating the treatment effect in the expertise-based and conventional designs. We recognize that expected patient outcomes may be better in the expertise-based design, which in turn may modify the estimated treatment effect. In particular, a larger treatment effect in the expertise-based design can sometimes offset a higher standard error arising from the confounding of clinician effects with treatments.These concepts are illustrated with data taken from a randomized trial of two alternative surgical techniques for tibial fractures.     

《系统解剖学》CAI的设计

主要研究了《系统解剖学》CAI课件的设计与实现问题。该软件采用较先进的信息库设计方法及流行的OLE技术,使用VB编程、利用OLE技术进行数据连接、用ACCESS作为数据库开发平台进行数据库型CAI的设计。本CAI采用多媒体技术,给学习者提供了友好的学习环境。     

新型动态压力监测肠内营养输液泵的研制

目的：研究设计一种带有动态压力监测功能的肠内营养输液泵,并阐述其原理和实现方法。方法：在常规输液泵推送药液原理的基础上结合临床应用,设计出动态测压部件和基本功能部件系统。结果：通过实施输液过程中动态压力监测,避免患者肠内营养支持中出现机械并发症。设计方案提供了一种可实现自动控制营养液输注速度和总量的装置,并可实现全过程的安全监控。结论：新型动态压力监测肠内营养输液泵的研制可提高肠内营养泵的安全性,同时可极大地减轻医护人员的工作强度,提高护理工作的质量和效率。