浅析城市生活垃圾处理方案选择

本文对城市生活垃圾处一方案选择进行了初步的探讨，指出在进行方案选择时应对城市概况、技术、经济和财务、环境以及法律 政策等五方面的因素进行全面、详细的调查、分析和评价，并在此基础上进行总体评价，这样才能选择出最适宜的方案。     

转基因食品样品检验方案的制定和优化

转基因食品的样品检验是安全性评价的重要内容。制定样品检验方案，优化检验项目，选择检验技术是保证检验结果科学性和客观性、提高样品检验工作效率和水平的重要环节。本文从转基因食品样品检验的目的和作用、检验方案制定的依据和原则、检验项目和方法的选择、检验结果的评价等方面，研究制定和优化转基因食品样品检验方案的策略，提出相应的样品检验模型。     

中等及低收入国家和地区开展宫颈癌筛查方案的成本效果分析

目的对中等及低收入国家和地区开展的基于肉眼观察、细胞学检测和HPV DNA检测技术的宫颈癌筛查方案的成本效果分析研究进行系统评价,衡量筛查方案的成本效果。方法检索中等及低收入国家和地区宫颈癌筛查方案的成本效果评价研究。对纳入文章进行质量评价,运用描述性方法系统评价筛查策略的经济性。结果根据纳入和排除标准,共纳入19篇文献。纳入文献经质量评价、描述性分析对文献的基本信息、评价方法、评价结果进行系统总结。结论对于中等及低收入国家而言,在经济条件十分有限的情况下,文献推荐选择肉眼观察筛查方案,如果经济条件允许,则更为推荐HPV DNA筛查方案。     

基于医患偏好差异的治疗方案决策模型

文章针对医生、患者等对治疗方案的疗效和风险等存在不同的偏好,难以达成一致的治疗决策,提出了一种基于离散选择实验（DCE）和逼近理想解法（TOPSIS）的治疗方案选择方法。在应用离散选择实验调查患者及医生的偏好基础上,引入逼近理想解法对各种治疗方案进行定量评价。最后,以转移性肾细胞癌的靶向治疗为例说明该方法的具体应用,并比较了医生决策、患者决策、医患共同参与决策等不同决策方式下各治疗方案的评价排序,为临床决策制定提供参考意见。     

农村大病统筹医疗保险方案选择的约束条件

农村医疗保险方案选择的诸多约束条件有５个主要方面，费率水平，家民主观接受程度和客观接受程度，方案覆盖范围，控制不合理的医疗需求。对以上问题逐次进行讨论允我目标决策技术能够满足以上诸多约束条件的方案，给出了方案的估价和决策选择，并用样本人嫩实际数据加以验证。     

TOPSIS法在医院绩效评价中的应用

TOPSIS(TechniqtIe for Order Preference by Similarity to Solution)又叫理想解法，是一种有效的多指标决策方法，近年来也应用于多指标的综合评价。该方法基于归一化后的原始数据矩阵，找出有限方案中的最优方案(理想解)和最劣方案(负理想解)，然后获得某一方案与最优方案和最劣方案的距离，从而得出该方案与最优方案的接近程度，并以此作为评价各方案优劣的依据。医院临床科室绩效评价，因涉及的评价因数较多，传统的检查评分法已不能适用。     

医疗服务价格评价指标体系的应用

按病种付费是指针对同一种疾病，无论医院采用什么治疗方案，消耗多少人力、药品和材料，需要多少住院日，只要达到了同样的治疗效果，就按一定的标准进行支付。为了对已经建立起来的“医疗服务价格评价指标体系”进行实用性、操作性方面的检验，我们选择某市医疗保险“单纯性阑尾炎”单病种付费这一改革举措进行了评价，有关结果如下。     

模糊综合评价法在医疗装备维修决策中的应用

通过运用模糊综合评价方法，构建了基于最大隶属度原则的医疗装备维修方案多属性模糊决策模型，解决了利用RCM逻辑决断图．进行维修方式的决策而产生不确定性和模糊性影响。最后通过CT机高压发生器故障维修的实例应用．表明模型对实际工作中最佳维修方案的选择可提供有效指导。     

宫颈疾病筛查方案卫生经济学评价研究进展

宫颈疾病是指在宫颈区域发生的各种病变,包括炎症、损伤、肿瘤、癌前病变、畸形和子宫内膜异位症,是女性的常见疾病.据世界卫生组织统计,全世界每年有50万例新发宫颈疾病病例,中国每年新发病例约为13.15万例,占全世界的28.8％[1].有研究表明,近年来中国宫颈疾病的发病率呈不断上升趋势,并逐步向年轻化发展[2].卫生经济评价方法是通过分析卫生规划的经济效果(成本、效果或投入、产出),对备选方案进行评价和选优的方法[3].不同的筛查方案之间的成本效果、效益及效用各不相同,本研究为了解不同宫颈疾病筛查方案的卫生经济学评价,为卫生决策者选择适当的宫颈疾病筛查方案提供依据,对国内外宫颈疾病筛查方案的卫生经济学评价研究进展综述如下.     

彩色多普勒超声心动图诊断小儿先天性心脏病的临床意义

近年来，随着彩色多普勒（CDE）的广泛使用，为小儿先天性心脏病（CHD）的早期诊断、手术方案选择和术后评价提供了一种无创而准确的检测手段。     

Increasing dietetic referrals: Perceptions of general practitioners,practice nurses and dietitians

Aim: To examine Australian private practice dietitians' relationships with general practitioners and practice nurses as a factor that influences dietetic referrals. Methods: Semistructured telephone interviews and an online survey were conducted with Australian private practice dietitians (n = 52 and n = 90, respectively) between April and May 2008. Semistructured questionnaires were conducted with general practitioners (n = 11) and practice nurses (n = 12) from the ‘GP Access’ Division of General Practice between March and July 2007. Results: General practitioners' relationships with dietitians were believed to be the primary influencing factor on referral, provided by 81% of survey dietitians and 25% of interview dietitians. The most common means of initially forming relationships with general practitioners were face‐to‐face introduction (48%) and introductory letters (37%). Patient feedback via letter, fax or email was the most popular method of maintaining relationships with general practitioners (77%). Meeting with general practitioners in person was believed to be the most effective activity in building relationships with general practitioners and increasing referral rates (42%). Referral was made easier for general practitioners by providing paper (37%) or electronic (19%) referral forms and contact details (19%). The majority of general practitioners and dietitians believed that the ‘Allied Health Services Under Medicare’ made it easier to refer to a dietitian. Conclusions: Dietetic referrals can be encouraged through good relationships between general practitioners, practice nurses and dietitians. Private practice dietitians would benefit from cultivating relationships with general practitioners and practice nurses through personal contact and providing good patient feedback.     

Old issues confront biotechnology and new products: John Petricciani discusses the risks and rewards associated with the use of abnormal cells for biological production

Few decisions have had such a far-reaching effect on the development and production of biological products as that made in 1954 by the Armed Forces Epidemiological Board. It was at that point that a decision had to be made regarding the use of HeLa cells as the substrate for an experimental adenovirus vaccine. Because HeLa cells were rejected in favour of ‘normal cells’, a philosophy emerged which equated anything other than primary cell cultures from normal tissues of normal animals as dangerous and unacceptable. It was a philosophy which probably made sense at the time, and which had the general support of the biomedical community. However, once it became established as a standard of practice, any suggestion to depart from that position was met with significant obstacles as exemplified by the diploid cell line saga.     

Antenatal care in high-risk pregnancies

A retrospective analysis of the antenatal records of women who gave birth to live babies was conducted in the three Districts of the East Sussex Health Area in 1977. A high-risk group was identified and the antenatal care for them was compared with that given to mothers in general. Comparison was also made between Districts. Women in the high-risk group were similar to those in the general group with respect to the number of antenatal visits. Overall this was also found with respect to when the last visit was made, but there were differences among those with short or long gestations. Pregnant women at high risk were more likely to be supervised by the hospital team exclusively during the antenatal period than those in the general group. Maternal characteristics which might have been used to identify high-risk pregnancies were often not recorded. High-risk mothers more frequently had infants with Apgar scores of less than 5 at one minute and birth weights of 2500 g or less than did women in the general group. However, it would appear that District policy on health care varied significantly since various aspects of care were found to be more dependent on the District concerned than on the risk group involved.     

A comparative study of teleconsultations versus face-to-face consultations

We compared the diagnoses made by one dermatologist via telemedicine with those of another dermatologist made in a face-to-face consultation. The patients first underwent a teledermatology consultation and then a face-to-face consultation. A general practitioner was present with the patient in the videoconference studio. Videoconferencing equipment connected at 384 kbit/s was used. The doctor-patient relationship and the satisfaction of the patients and dermatologists in the two settings were assessed, as well as technical conditions during the videoconferences. There were 121 patients, with a mean age of 40 years (range 17-82 years). There was a high degree of concordance between the two sets of diagnoses, with 72% complete agreement and 14% partial agreement between the two dermatologists. A total of 116 patients (96% of those included) completed a questionnaire. Both the patients and the dermatologists were in general satisfied with the videoconferences. Videoconferencing with a participating general practitioner may be useful in dermatology, but the technique should be used only for selected patients.     

Food advertising in the age of obesity: content analysis of food advertising on general market and african american television

OBJECTIVE: To document the types of foods advertised and weight-related nutritional claims made during advertisements appearing on general market and African American television programming. DESIGN: Content analysis of 553 food advertisements appearing during 101.5 prime-time television hours. OUTCOME MEASURES: Advertisements were classified according to general category (fast-food restaurant, sit-down restaurant, packaged food), specific food type, and the presence of a weight-related nutritional claim. ANALYSIS: The type of foods advertised and nutritional claims made on general market and African American programs were compared using t and chi-squared tests. RESULTS: More food advertisements appeared during African American programs than general market programs. These advertisements were more likely to be for fast food, candy, soda, or meat and less likely to be for cereals, grains and pasta, fruits and vegetables, dessert, or alcohol. Of all of the food advertisements, 14.9% made a weight-related nutritional claim. More claims related to fat content appeared during African American programming, whereas more light and lean claims appeared in general market advertisements. CONCLUSIONS AND IMPLICATIONS: Practitioners and policy makers should be aware of the prevalence of food advertisements and their potential impact on knowledge and behavior and should consider working more closely with food manufacturers to encourage the creation and promotion of weight-friendly foods. Meanwhile, nutrition educators can help by teaching consumers critical thinking skills as may relate to food advertisements.     

Early medical career choices and eventual careers

The revised structure of hospital specialist training being introduced in the United Kingdom means that a doctor wanting a career in a hospital specialty will need to be confident that his or her early career choice, made within 3 years of qualification, is realistic. Using data from a longitudinal study of the 1983 cohort of UK medical graduates, the early career choices made by over 2000 doctors were compared with their employment 11 years after qualification. At year 11 65% of the doctors were working within the first choice they had expressed towards the end of their pre-registration year, and 79% were employed in their year 3 first choice. There was, however, important variation within this general picture: lower predictive value was associated with choices made by women; choices for hospital mainstreams rather than for general practice; and choices that were less than definite. The recent drop in popularity of general practice as a career choice of new graduates in the UK, and the steady increase in the proportion of women graduates, mean that the predictive value of the career choices of recent graduates may prove to be lower than that of the 1983 cohort.     

Medical students' perceptions of an undergraduate general practice preceptorship.

A survey was undertaken to evaluate an undergraduate general practice preceptorship by means of an open-ended six-item questionnaire given to students at the end of their general practice attachment. The aim of the survey was to evaluate the preceptorship as a learning experience and to examine ways in which the preceptorship might be improved. Questionnaires from two medical student years (1985 and 1990) were examined retrospectively. Of 398 potential responders, 386 (97%) had completed questionnaires. Students expressed a very high level of satisfaction with the attachment and this was expressed most often in terms of the personal interest shown by the general practitioner, the variety of clinical problems encountered, and the experience gained in managing common clinical problems. Areas of the attachment which students felt could be improved were: involvement in the consultation, the time constraints on teaching and the teaching of practical skills. The paper discusses possible improvements which could be made to preceptorship programmes on the basis of these findings.     

广东省城市社区全科医师培训模式探讨

目的：为了提高社区卫生技术人员的业务水平，建立起一支高素质的社区医师队伍，结合广东省的实际情况，探讨全科医师的培训模式。方法：以分层抽样的方法，从广东省抽取9个城市，按“有关全科医学教育问卷”进行调查，召开座谈会和现场实地考察。结果：根据基层卫生技术人员的职称和学历情况，采取岗位培训，在职学历教育，本科学历教育等多层次和多种形式并举的培训模式，并提出设置“助理全科医师”职称的建议。结论：结合实际，讲求实效，做好全科医师的培训工作，保证城市社区卫生服务健康持续发展。     

Doctor-patient communication and the quality of care

In this article a comparison is made between three independent sources of assessment of medical consultations. A panel of 12 experienced general practitioners rated 103 consultations with hypertensive patients on the quality of psychosocial care. There was a wide consensus between the judges, resulting in a high reliability score. Two contrasting groups were formed: consultations that were rated high and those rated low in quality of psychosocial care. A comparison was made between this general assessment of the quality of psychosocial care and a more detailed assessment of the same consultations on nine much used communication variables made by trained psychologists. Knowledge about doctor-patient communication proved to predict very well as to which quality group the consultations belonged. A very high percentage (95%) was predicted accurately, solely on the basis of these nine communication variables. Affective behaviour, and especially nonverbal affective behaviour had the strongest predictive power. In the last part of the study a third source of assessment, i.e. patients' satisfaction was compared with both other sources. Much lower relationships were found, although most were in the predicted direction. Affective behavior seems to be the most important in determining patient's satisfaction. The implications of these findings are discussed.