Public involvement in health care priority setting: an economic perspective

Background  Public involvement in health care decision making and priority setting in the UK is being promoted by recent policy initiatives. In 1993, the British Medical Association called for public consultation where rationing of services was to be undertaken. The approach to priority setting advocated by many health economists is the maximization of quality adjusted life years (QALYs). Typically, for a particular health care programme, the QALY calculation takes account of four features: (1) the number of patients receiving the programme, (2) the survival gain, (3) the gain in quality of life and, (4) the probability of treatment success. Only one feature, that relating to quality of life, is based upon public preferences. If the QALY is to be used as a tool for health care resource allocation at a societal level then it should incorporate broader societal preferences.
Methods  This study used an interview-based survey of 91 members of the general public to explore whether the traditional QALY maximization model is a good predictor of public responses to health care priority setting choices.
Results and conclusions  Many respondents did not choose consistently in line with a QALY maximization objective and were most influenced by quality of life concerns. There was little support for health care programmes that provided a prognostic improvement but left patients in relatively poor states of health. The level of respondent engagement in the survey exercise was not sensitive to the provision of supporting clinical information.     

视细胞移植术后视网膜色素上皮的结构变化

获得纯化的由大肠杆菌表达的小鼠 Ｆａｓ配体（Ｆａｓ ｌｉｇａｎｄ,ＦａｓＬ）。方法：以质粒 ｐＥＴ－１５ｂ为载体,在大肠杆菌ＢＬ２１（ＤＥ３）中表达小鼠的ＦａｓＬ,用金属螫合亲和层析法纯化。结果：转化菌中,重组质粒是稳定的,异丙基－β－Ｄ硫代半乳糖苷可诱导小鼠ＦａｓＬ的表达 ,金属螫合亲和层析法可以初步纯化此蛋白。结论：在大肠杆菌中表达出小鼠的ＦａｓＬ,并得到初步纯化。     

增免灵对活动性肺结核患者的疗效及外周血T淋巴细胞亚群的影响

目的　比较常规疗法伍用增免灵与单用常规疗法对活动性肺结核的疗效及外周血Ｔ 淋巴细胞亚群的影响。方法　抽取常规化疗组（６１ 例）、常规化疗加增免灵组（７２ 例） 及健康对照组（３５ 例） 患者外周血,用ＡＰＡＡＰ法测定外周血淋巴细胞亚群。结果　活动性肺结核患者外周血ＣＤ＋３ 及ＣＤ＋４ 百分率及ＣＤ＋４ ／ＣＤ＋８ 比值显著低于健康对照组（ Ｐ＜ ０．０５） ,ＣＤ＋８ 高于健康对照组。结论　短程化疗伍用增免灵可显著改善活动性肺结核的疗效及细胞免疫状况。     

尾部悬吊及恢复过程中大鼠动脉血管收缩反应的变化

目的 探讨模拟失重下动脉收缩反应变化的时程特征及其可逆性。方法 采用尾部悬吊大鼠模型模拟失重,利用离休动脉环测定血管收缩反应的变化。结果 尾部悬吊２ｗｋ后,大鼠的腹主动脉、肠系膜动脉和股动脉收缩反应明显降低,而颈总动脉无明显改变;悬吊４ｗｋ后,肠系膜动脉和股动脉的收缩反应与悬吊２ｗｋ相比有进一步的降低;悬吊８ｗｋ大鼠的动脉血管收缩反应性与悬吊４ｗｋ相比无明显差异;４ｗｋ尾部悬吊大鼠解除悬吊后５ｗｋ     

模拟失重大鼠比目鱼肌小动脉风各级血管内径的变化

目的 探讨模拟失重是否可引起后肢肌肉小动脉网各级血管内径发生改变及其可逆性。方法 采用墨汁灌注法观察尾部悬吊４ｗｋ（ＳＵＳ－４）,悬吊４ｗｋ后恢复１ｗｋ（ＲＥＣ－１）、恢复５ｗｋ（ＲＥＣ－５）,以及对照（ＣＯＮ）大鼠比目鱼肌小动脉网各组血管内径的变化。结果 在ＳＵＳ－４组,比目鱼肌的营养动脉、弓状小动脉及Ｖ、Ⅱ级模行小动脉的内径,较ＣＯＮ组分别减小了３１％、２９％、２８％及４１％（均为Ｐ〈０．０１     

轻、中度缺氧对事件相关电位的影响及不同刺激模式的比较

目的 观察轻、中度缺氧对脑事件相关电位（ＥＲＰ）的影响,比较不同刺激模式发的ＥＲＰ对缺氧的敏感性,方法１２名受试者在地面、２５００ｍ和４３００ｍ匠心同度（吸放低氧混合气）分别进行视觉Ｏｃｄｄｂａｌｌ、Ｓｔｅｒｎｂｅｒｇ记忆量（ＭＳＥＴ）为１ 和ＭＳＥＴ为３的任务测试,记录ＥＲＰ的Ｐ３潜伏期、波幅和反应时（ＲＴ）及反应错误率（ＥＲ）。结果 ４３００ｍ高度缺氧时Ｐ３潜伏期显著延长,任务难度较大时ＥＲ增     

Retained intravitreal lens fragments after phacoemulsification: a clinicopathological correlation

AIMS: To explore the relation between clinical course and timing of vitrectomy with the nature and intensity of intraocular inflammatory response in eyes with retained intravitreal lens fragments following complicated phacoemulsification. METHODS: Prospective evaluation of 22 eyes with retained lens fragments with emphasis on corneal clarity, uveitis, intraocular pressure (IOP), timing of vitrectomy, and visual outcome. Numbers of different types of inflammatory cells in vitreous washings were counted, masked to clinical details, in three non-overlapping adjacent high power fields. Relations between clinical and pathological findings were assessed. RESULTS: The IOP was raised in 19 eyes before vitrectomy and remained high in nine postoperatively. The latter had higher median total cell count (104 cells/mm(2)) than those with normal postoperative IOP (37 cells/mm(2)) but this difference was not statistically significantly different (p=0.17). Nine of 22 eyes underwent vitrectomy within 1 week of cataract surgery. Median total cell count in these eyes was 20 cells/mm(2) compared with 140 cells/mm(2) in eyes vitrectomised later-this difference was statistically significant (p <0.001). Final visual acuity was 6/12 or better in 13 eyes, these had fewer intravitreal inflammatory cells than the remaining six with poor visual outcome and no pre-existing cause for this (three patients excluded) (p=0.02). Macrophages were the predominant inflammatory cell type. CONCLUSION: There was significantly less inflammatory cell activity in eyes which had retained lens fragments removed early (within 1 week). Later removal was associated with persistently elevated IOP and poorer visual outcome.     

Effect of Flumazenil on Ventilatory Drive during Sedation with Midazolam and Alfentanil

Background: Patients who receive a combination of a benzodiazepine and an opioid for conscious sedation are at risk for developing respiratory depression. While flumazenil effectively antagonizes the respiratory depression associated with a benzodiazepine alone, its efficacy in the presence of both a benzodiazepine and an opioid has not been established. This study was designed to determine whether flumazenil can reverse benzodiazepine-induced depression of ventilatory drive in the presence of an opioid.

Methods: Twelve healthy volunteers completed this randomized, double-blind, crossover study. Ventilatory responses to carbon dioxide and to isocapnic hypoxia were determined during four treatment phases: (1) baseline, (2) alfentanil infusion; (3) combined midazolam and alfentanil infusions, and (4) combined alfentanil, midazolam, and "study drug" (consisting of either flumazenil or flumazenil vehicle) infusions. Subjects returned 2-6 weeks later to receive the alternate study drug.

Results: Alfentanil decreased the slope of the carbon dioxide response curve from 2.14 +/- 0.40 to 1.43 +/- 0.19 l [dot] min sup -1 [dot] mmHg sup -1 (x +/- SE, P < 0.05), and decreased the minute ventilation at PET CO2 = 50 mmHg (V with dotE 50) from 19.7 +/- 1.2 to 14.8 +/- 0.9 l [dot] min sup -1 (P < 0.05). Midazolam further reduced these variables to 0.87 +/- 0.17 l [dot] min sup -1 [dot] mmHg sup -1 (P < 0.05) and 11.7 +/- 0.8 l [dot] min sup -1 (P <0.05), respectively. With addition of flumazenil, slope and V with dot sub E 50 increased to 1.47 +/- 0.37 l [dot] min sup -1 [dot] mmHg sup -1 (P < 0.05) and 16.4 +/- 2.0 l [dot] min sup -1 (P < 0.05); after placebo, the respective values of 1.02 +/- 0.19 l [dot] min sup -1 [dot] mmHg sup -1 and 12.5 +/- 1.2 l [dot] min sup -1 did not differ significantly from their values during combined alfentanil and midazolam administration. The effect of flumazenil differed significantly from that of placebo (P < 0.05). Both the slope and the displacement of the hypoxic ventilatory response, measured at PET CO2 = 46 +/- 1 mmHg, were affected similarly, with flumazenil showing a significant improvement compared to placebo.