What does it mean to involve consumers successfully in NHS research? A consensus study

OBJECTIVE: To obtain consensus on the principles and indicators of successful consumer involvement in NHS research. DESIGN: Consensus methods were used. An expert workshop, employing the nominal group technique was used to generate potential principles and indicators. A two-round postal Delphi process was used to obtain consensus on the principles and indicators. SETTING AND PARTICIPANTS: Participants were drawn from health, social care, universities and consumer organizations. A purposive sampling strategy was used to identify people who had experience and/or knowledge of consumer involvement in NHS research. Six researchers and seven consumers participated in an expert workshop. Ninety-six people completed both rounds of the Delphi process. MAIN OUTCOME MEASURES: Consensus on principles and indicators of successful consumer involvement in NHS research. RESULTS: Eight principles were developed through an expert workshop and Delphi process, and rated as both clear and valid. Consensus was reached on at least one clear and valid indicator by which to measure each principle. CONCLUSIONS: Consensus has been obtained on eight principles of successful consumer involvement in NHS research. They may help commissioners, researchers and consumers to deepen their understanding of this issue, and can be used to guide good practice.     

角膜塑型术矫正近视二年后的临床观察

目的 :探讨角膜塑型术 (Orthokeratology ,简称Or tho K镜 )矫正近视的远期疗效 ,了解其对近视的矫正及控制近视进展的效果。并观察其安全程度。方法 :配戴Ortho K镜二年以上的青少年近视眼患者 ,共 86例 16 6眼 ,平均年龄(15 .5± 2 .6 )岁 ( 10～ 2 5岁 ) ,平均屈光度 ( - 4 .0 2± 1.78)D( -1.5～ - 7.0D)。对配戴前、后的角膜曲率、角膜地形图、角膜厚度、眼轴、眼压进行检测 ,平均观察期为 ( 2 8.2 5± 3.74 )个月。结果 :配戴前后平均裸眼视力分别为 0 .2 1± 0 .10和0 .99± 0 .2 3,差异有非常显著性 (P <0 .0 1) ;配戴前后角膜水平曲率均值分别为 ( 4 3.0 5± 1.10 )D和 ( 4 0 .84± 1.38)D ;配戴前后眼轴 (眼球前后径 )均值分别为 ( 2 4 .93± 0 .82 )mm和( 2 5 .16± 0 .82 )mm ,每年眼轴增长均值为 ( 0 .12± 0 .4 1)mm ;配戴前后角膜厚度均值分别为 ( 0 .5 6 5± 0 .0 30 )mm和 ( 0 .5 5 7±0 .0 34)mm ,配戴后角膜厚度平均变薄 0 .0 0 9mm ,差异有显著性 (P <0 .0 1) ;配戴前后眼压均值分别为 ( 15 .95± 2 .92 )mmHg和 ( 15 .35± 2 .6 0 )mmHg ,配戴后眼压平均下降 0 .6 0mmHg,差异有显著性 (P <0 .0 1)。配戴Ortho K镜期间有 79眼发生过角膜点状浸润 ,占配戴眼数的 4 7.31%。结论 :Or t     

Social work, general practice and evidence-based policy in the collaborative care of older people: current problems and future possibilities

While collaborative (or joint) working between social services and primary healthcare continues to rise up the policy agenda, current policy is not based on sound evidence of benefit to either patients or the wider community. Both sets of practitioners report benefits for their own work from adopting new arrangements for collaboration. The underlying assumption behind much of this activity is that a greater degree of integration provides benefits to both users and their carers, a perspective that at times obscures the issue of resource availability, especially in the form of practical community services such as district nursing and home help. At the present time there is insufficient evidence to demonstrate that formal arrangements for collaborative working (CW) are better than those forged informally between committed individuals or teams. Furthermore, arrangements for CW have not hitherto been widely evaluated in systematic studies with a comparative design and focus on outcomes for users and carers rather than on processes. In this paper we propose a number of process measures for future evaluation of CW: (1) study populations must be comparable; (2) details of how services are actually delivered must be obtained and colocation should not be assumed to mean collaboration; (3) care packages in areas of comparable resources should be examined; (4) both destinational outcomes and user‐defined evaluations of benefit should be considered; (5) possible disadvantages of integrated care also need to be actively considered; (6) evaluations should include an economic analysis. Those implementing new policies in Primary Care Trusts have, at present, little sound evidence to guide them in their innovative work. However, they should take the opportunity to rigorously test the advantages and disadvantages of collaboration.     

试论医院工程项目的经济评价

工程项目经济评价的战略性、前瞻性、科学性、经济性、有效性和安全性是项目决策的前提与基础。目前,医院对工程项目的经济评价沿用的是传统的成本核算方法,是对医院内部之间的财务成本核算与管理的评价,评价缺乏对医院隐含的成本因素中的战略性定位分析、成本动因分析、价值链分析、全寿命周期经济效益分析和医疗市场发展态势分析。传统的评价方法己不能满足和适应医院战略管理的需要,实施战略成本管理方法,全方位、多角度采集信息,进行战略性的分析、评价,是现阶段医院工程项目经济评价的有效方法。     

基于小波变换纹理分析的医学图像检索

根据医学图像的特点．提出了一种基于哈尔小波变换纹理分析的图像检索方法．并与基于共生矩阵的纹理识别方法进行比较和分析。据此．实现了一个图像检索原型系统。实验证明．本方法具有良好的检索效果。     

本地实验犬淋巴细胞染色体核型分析

目的通过犬的染色体核型分析,为诊断犬染色体病以及进行犬的分子细胞学研究奠定了基础。方法采集13条正常本地犬(6条雌性、7条雄性)外周血进行淋巴细胞培养,经秋水仙素处理后制备常规及G带染色体标本并进行核型分析。结果本地犬的染色体形态结构表现出很好的一致性,其染色体数为2n=78,雌性染色体核型为78,XX,雄性染色体核型为78,XY。39对染色体中有38对常染色体均为端着丝粒染色体,长度逐渐递减;1对性染色体为中央着丝粒,X染色体最大并与人X染色体形态极其相似,Y染色体最小。结论染色体G带核型分析发现,可以明确鉴别犬第1～21号常染色体和性染色体,但很难可靠地鉴别其余的17对常染色体。     

NP与EP方案治疗晚期非小细胞肺癌的比较

为观察比较长春瑞滨（NVB）联合顺铂（DDP）组成的NP方案与依托泊苷（Vp-16）联合DDP组成的EP方案,治疗晚期非小细胞肺癌（non-small cell lung cancer,NSCLC）的疗效和毒性反应,选取82例晚期NSCLC患者,随机分为NP和EP两组进行化疗.结果示,NP组有效率为52.5%（21/40）,EP组有效率为28.6%（12/42）,NP组疗效优于EP组,但差异尚无统计学意义,u=1.855,P=0.064.两组剂量限制毒性均为骨髓抑制,消化道反应可以耐受.初步研究结果提示,NP方案治疗晚期NSCLC的疗效高于EP方案.     

肺癌组织中黑色素瘤抗原-A3基因mRNA的表达及其序列点突变分析

目的检测肺癌组织中黑色素瘤抗原-3基因(MAGE-A3)mRNA的表达。方法用逆转录-套式聚合酶链反应(RT-PCR)对31例肺癌患者癌组织和相应癌旁组织MAGE-A3mRNA表达情况进行测定;PE-377DNA测序仪对5例10个RT-PCR扩增产物中的目的基因片段进行DNA序列测定。结果31例肺癌患者癌组织中26例表达MAGE-A3mRNA,阳性率为83.9%;相应的癌旁组织均未表达。DNA序列测定证明PCR扩增产物中目的基因片段均为MAGE-A3cDNA序列,所测5例样本中4例样本有两个相同位置的碱基发生了点突变(C2773→T2773;G2807→A2807),导致一个氨基酸残基改变(E143→K)。结论MAGE-A3mRNA在肺癌中呈高比例表达,提示此抗原有可能作为肺癌患者免疫治疗的靶抗原。我国肺癌患者中存在MAGE-A3基因个别位点的变异。