作业成本法在医疗服务项目成本管理中的应用

立足精细化管理,加强医疗服务项目成本管理是当前医院经营治理的必然要求.本文首先介绍了医院成本核算的方法与体系,然后以某大型医院超声科为例,运用作业成本法核算了2011年某季度4个主要医疗服务项目的成本,与传统成本法及收费标准进行了对比分析,提出了改进医疗服务价格成本测算方法、开展医疗服务项目作业成本管理的思路与建议.     

类风湿关节炎中医证候量表条目筛选简

目的：制定类风湿关节炎中医证候量表,应用多种统计学方法筛选并优化条目。方法：采用横断面调查法,对符合纳入标准的201名类风湿关节炎患者实施问卷调查,运用频数分析法、因子分析法、相关系数法、逐步回归分析、克朗巴赫系数法和重复测量等筛选方法对资料数据进行分析。结果：通过多种方法的联合应用,最终保留了35个四诊条目,构成了类风湿关节炎中医证候量表。结论：条目的筛选,可综合运用多种统计学方法,掌握保留条目的尺度,才能保证量表有良好的信效度。     

模因论视阈下《黄帝内经》中文化专有项英译策略探析

模因论是将文化和进化论相结合的一种理论,可为《黄帝内经》中文化专有项的英译引入信息复制模式。译者应根据模因的类型,相应地采用直译、音译、意译、增译等不同的翻译策略,实现文化专有项的等值等效翻译,达到文化传播的目的。     

Using the Movember Foundation’s GAP3 cohort to measure the effect of active surveillance on patient-reported urinary and sexual function—a retrospective study in low-risk prostate cancer patients

BackgroundActive surveillance (AS) for low-risk prostate cancer (PCa) is intended to overcome potential side-effects of definitive treatment. Frequent prostate biopsies during AS may, however, impact erectile (EF) and urinary function (UF). The objective of this study was to test the influence of prostate biopsies on patient-reported EF and UF using multicenter data from the largest to-date AS-database.MethodsIn this retrospective study, data analyses were performed using the Movember GAP3 database (v3.2), containing data from 21,169 AS participants from 27 AS-cohorts worldwide. Participants were included in the study if they had at least one follow-up prostate biopsy and completed at least one patient reported outcome measure (PROM) related to EF [Sexual Health Inventory for Men (SHIM)/five item International Index of Erectile Function (IIEF-5)] or UF [International Prostate Symptom Score (IPSS)] during follow-up. The longitudinal effect of the number of biopsies on either SHIM/IIEF-5 or IPSS were analyzed using linear mixed models to adjust for clustering at patient-level. Analyses were stratified by center; covariates included age and Gleason Grade group at diagnosis, and time on AS.ResultsA total of 696 participants completed the SHIM/IIEF-5 3,175 times, with a median follow-up of 36 months [interquartile range (IQR) 20–55 months]. A total of 845 participants completed the IPSS 4,061 times, with a median follow-up of 35 months (IQR 19–56 months). The intraclass correlation (ICC) was 0.74 for the SHIM/IIEF-5 and 0.68 for the IPSS, indicating substantial differences between participants’ PROMs. Limited heterogeneity between cohorts in the estimated effect of the number of biopsies on either PROM were observed. A significant association was observed between the number of biopsies and the SHIM/IIEF-5 score, but not for the IPSS score. Every biopsy was associated with a decrease in the SHIM/IIEF-5 score of an average 0.67 (95% CI, 0.47–0.88) points.ConclusionsRepeated prostate biopsy as part of an AS protocol for men with low-risk PCa does not have a significant association with self-reported UF but does impact self-reported sexual function. Further research is, however, needed to understand whether the effect on sexual function implies a negative clinical impact on their quality of life and is meaningful from a patient’s perspective. In the meantime, clinicians and patients should anticipate a potential decline in erectile function and hence consider incorporating the risk of this harm into their discussion about opting for AS and also when deciding on the stringency of follow-up biopsy schedules with long-term AS.     

Electrospray ionization mass spectrometry identification of fibrinogen Banks Peninsula (γ280Tyr→Cys): a new variant with defective polymerization

Fibrinogen Banks Peninsula was identified in the mother of a patient referred for investigation following recurrent epistaxis. Coagulation tests revealed prolonged thrombin and reptilase times and a decreased functional fibrinogen level. Thrombin-catalysed release of fibrinopeptides A and B was normal, and no abnormalities were detected by DNA sequencing of the regions encoding the thrombin cleavage sites in the Aα and Bβ genes. Reducing SDS-PAGE and reverse-phase HPLC analysis of purified fibrinogen chains were normal, as was electrospray ionization mass spectrometry (ESI-MS) analysis of isolated Aα and Bβ chains. However ESI-MS revealed a mass of 48 345 D for the isolated γ chains, 31 D less than the measured mass of control chains (48 376 D). Since normal and abnormal γ chains were not resolved, this implies a 60–62 D mass decrease in 50% of the molecules. A 60 D decrease was confirmed when DNA sequencing indicated heterozygosity for a mutation of Tyr→Cys at codon 280 of the γ chain gene. Fibrin monomer polymerization revealed a delayed lag phase and reduced final turbidity and although factor XIIIa crosslinking of fibrinogen was normal, it is likely that this delay is due to impaired D:D self association. Recent crystallographic studies show residues γ280 and γ275 make contact across the D:D interface, suggesting a similar mechanism for the polymerization defects in fibrinogens Banks Peninsula and Tokyo II (γ275Arg→Cys).     

加强领导 努力做好民族地区妇幼卫生合作项目工作

青海省黄南州自１９９０年被确立为《加强中国基层妇幼卫生／计划生育服务》合作 项目县后，州政府加强领导，与各项目单位层层签订项目协议书，认真抓好组织落实工作。为保证 项目的实施，州政府领导注意在人员培训、健康教育等方面落实经费，完成了项目配套要求，保证 了各项工作的顺利开展。同时，还建立健全县、乡、村三级妇幼保健网，在加强妇幼保健三级网络建 设中，结合民族地区特点，推行妇保、儿保、计划生育“三位一体”的管理模式，使黄南州妇幼卫生项 目工作取得了前所未有的成绩，推动了全州妇幼卫生事业的发展。     

Schizotypy, marijuana, and differential item functioning

At least five studies report elevated schizotypy scores in cannabis users. The current research confirms higher schizotypy scores in regular cannabis users. Nevertheless, further analyses reveal that select items on the brief version of the Schizotypal Personality Questionnaire do not function comparably in current and former users. Multiple statistical approaches confirmed this problem, including the Mantel-Haenszel statistic, Rasch difficulty estimates, a logistic regression approach, the Breslow-Day (BD) statistic, and a combined decision rule using Mantel-Haenszel and BD together. Cannabis users appear to misinterpret at least one item, "I sometimes use words in unusual ways" making them more likely to endorse it even if they are no more schizotypal than the former users. Users might consider cannabis-related slang as an unusual use of words. Removing problematic items does not decrease the internal consistency of the measure, but eliminates the significant difference between current and former users. These results suggest that links between cannabis use and schizotypy require cautious interpretation and may arise from measurement problems.     

Symptom reduction in depression after treatment with L-tryptophan or imipramine. Item analysis of Hamilton rating scale for depression.

Thirty-eight in-patients with endogenous- and 20 in-patients with non-endogenous depression, took part in a multi-centre 3-week double-blind trial where patients were randomly allocated to treatment with either 6 g L-tryptophan or 150 mg imipramine daily. Item analysis of Hamilton ratings, before the investigation and weekly during the trial period demonstrated few statistically different mean scores on individual items between the two treatment groups. After 3 weeks' treatment a statistically significant item mean reduction on the 0.1% level was found in the item Agitation in favour of imipramine-treated, and in the item Work and Activities in favour of L-tryptophan-treated endogenously depressed patients. After 3 weeks' treatment a statistically significant item mean reduction on the 5% level was found in the item Suicide in favour of imipramine-treated non-endogenously depressed patients. The present study has shown that, after 3 weeks' treatment, imipramine and L-tryptophan has decreased the mean score on individual items of HRS in about the same degree.     

Some methodological issues in the development of quality of life measures for the evaluation of medical interventions*

This paper discusses a series of important methodological issues in developing targeted health-related quality of life measures in studies of the effects of medical interventions. Such measures cannot be developed unless the evaluator understands the life domains that medical interventions affect. Qualitative discovery methods are needed to obtain this understanding. Once domains are targeted for measurement, careful and systematic laboratory pilot work should be used to select initial scale items. Psychometric evaluation of response patterns in subsequent field tests is needed to assess the measures. Less concern should be directed to internal consistency reliability of scales in the psychometric evaluation and more to the ability of short scales to reproduce total scale variance and to provide precise measurement within the range of the outcome where effects are expected. The paper closes with a discussion of modern methods of item response scaling that can be used to address these issues.     

Bonding — retrospect and prospect

The ability to bond two substances together has become increasingly relevant in modern dental techniques. The success of diverse procedures such as the placement of a composite resin restoration, a porcelain veneer or a Maryland bridge, depends on effective bonding between two different materials. Bonding is dentistry of the future; materials can be combined to take advantage of the best properties of each component. Bonding enables smaller, less complex and less bulky restorations with, overall, more effective treatment but is more exacting in surface preparation techniques and less forgiving of error.