用科学理论指导"五四一"医院经营管理模式的研究

本文介绍了广东省第二人民医院,用科学理论指导"五四一"医院经营管理模式研究的改革实践.分别阐述了"五四一"医院经营管理模式的研究基础、方向和核心目标.     

预期无残疾寿命的计算及应用

预期无残疾寿命（ＥＬＷＤ）在国外公共卫生及老年医学研究中已得到普遍重视，但ＥＬＷＤ的计算中却存在着若干错误，直接影响着ＥＬＷＤ的正确使用。文章简述了ＥＬＷＤ的概念及原理，推导了正确的计算公式，并以实例说明了计算步骤及方法，对ＥＬＷＤ在医学研究中的应用进行了讨论。     

Heart health inequalities in Canada: modules, theory and planning

It is well known that prevalence and incidence rates of cardiovasculardisease (CVD) and CVD risk factors are not equally distributedamong socioeconomic groups. Known risk factors account for part,but not all of unequally distributed CVD rates. Socioeconomicconditions and psychosocial dynamics may explain another pareof the increased CVD rates. Theoretically, it may be possibleto lower CVD rates and CVD risk factor prevalence among lowersocioeconomic status (SES) groups by using a community development(socio-environment) strategy directed towards changes in socioenvrronmentalrisk conditions and psychosocial risk factors, rather than CVDrisk factors per Se. This article describes a protocol for sucha strategy based upon the planning work of Canadian health professionals,loosely organized under a project titled ‘Heart HealthInequalities in Canada’ This protocol incorporates baselinedata on CVD and CVD risk factor prevalence, but is premisedon actions negotiated between community organizations and healthauthorities, rather than defined unilaterally by health authorities.As such, program design activities and evaluation will differfrom a more general population-based risk factor reduction strategy.     

Development of a Novel Scale to Assess Life Fulfilment as Part of the Further Refinement of a Quality-of-Life Model for Epilepsy

Summary: We have been involved in developing a health-related quality-of-life model for use as an outcome measure in epilepsy. As part of the further development of this model, we have developed a measure of life fulfilment. This scale is based on methods previously described by Krupinski in 1980. The value of Krupinski's approach is the opportunity for patients to weight the numerous aspects of their quality of life and assess the discrepancy between their actual and desired circumstances. The life fulfilment scale has been shown to be reliable (α= 0.7) and valid. The scale is currently being applied to several clinical studies in epilepsy. We believe that the scale provides a valuable contribution to our health-related quality-of-life model.     

运用现代教育理论思想 提高医学课堂教学质量

本文依据三种现代教育理论思想的有益启示,围绕医学高等专科学校课堂教学质量的提升问题,提出以加强教育理论思想研修为突破口,进而采取更新教育观念、狠抓移植应用和改进教法学法来有效提高医学高等专科学校课堂教学质量的新思路。     

Adaptive group sequential design for phase II clinical trials: A Bayesian decision theoretic approach

Bayesian decision theoretic approaches (BDTAs) have been widely studied in the literature as tools for designing and conducting phase II clinical trials. However, full Bayesian approaches that consider multiple endpoints are lacking. Since the monitoring of toxicity is a major goal of phase II trials, we propose an adaptive group sequential design using a BDTA, which characterizes efficacy and toxicity as correlated bivariate binary endpoints. We allow trade‐off between the two endpoints. Interim evaluations are conducted group sequentially, but the number of interim looks and the size of each group are chosen adaptively based on current observations. We utilize a loss function consisting of two components: the loss associated with accruing, treating, and monitoring patients, and the loss associated with making incorrect decisions. The performance of our Bayesian modeling, and the operating characteristics of decision rules under a wide range of loss function parameters are evaluated using seven scenarios in a simulation study. Our method is illustrated in the context of a single‐arm phase II trial of bevacizumab, gemcitabine, and oxaliplatin in patients with metastatic pancreatic adenocarcinoma. Copyright © 2009 John Wiley & Sons, Ltd.     

后现代心理学概观

后现代心理学家反对以往的心理学理论和流派把心理或行为看作是一个独立于研究者的“实体”。后现代心理学的典型特征是反对基础主义和本质主义。它认为心理现象并不是一种“精神实在” ,而是一种文化的社会建构。后现代心理学的理论基础是社会建构论 ,多元文化论、后现代女性心理学都是后现代心理学的重要形式。     

Is the apparent U-shape of well-being over the life course a result of inappropriate use of control variables? A commentary on Blanchflower and Oswald (66: 8, 2008, 1733–1749)

In their article in this journal “Is well-being U-shaped over the life cycle?” Blanchflower and Oswald (Blanchflower, D.G., & Oswald, A.J. (2008). Is well-being U-shaped over the life cycle? Social Science & Medicine, 66, 1733–1749) report the results of an ambitious cross-national study of age and well-being and conclude that in most societies studied the well-being of adults tends to be high in young adulthood and old age and lowest around age 40. I argue that the appearance of this U-shaped curve of well-being is the result of the use of inappropriate and questionable control variables. The most clearly inappropriate control variable is marital status, the control of which to a large extent accounts for the U-shaped curve. Most researchers who have studied the relationship between being married and being happy believe that happiness affects marital status (happier people are more likely to marry and stay married), and of course a variable that is affected by the dependent variable should not be included as a control variable in a simple recursive model. Such control variables as income and education are suspect because the relationship between them and well-being is likely to be partially spurious, and such variables as race and whether or not persons lived with both parents at age 16 should not be controlled, because they cannot affect or be affected by age. Finally, year of survey should not be controlled because of the age-period-cohort conundrum, which makes including age, period, and cohort all as predictor variables in a regression inappropriate (and impossible if the three variables are measured precisely and comparably). The only clearly appropriate control variable is birth cohort, and when only it is controlled, the regression data become estimates of how the well-being of persons has actually changed as they have gone through the life course. I argue that such estimates are much more useful than the counterfactual abstractions provided by Blanchflower and Oswald (Blanchflower, D.G., & Oswald, A.J. (2008). Is well-being U-shaped over the life cycle? Social Science & Medicine, 66, 1733–1749), and I conclude that those authors (or someone else) could make a very important contribution by redoing their analyses with birth cohort as the only control variable. I do that with the American happiness data and find that the results do not come close to the U-shaped pattern.     

CXCL10 haplotypes and multiple sclerosis: association and correlation with clinical course

CXCL10 (interferon- γ -inducible protein-10) levels are increased in cerebrospinal fluid of multiple sclerosis (MS) patients with symptomatic attacks of inflammatory demyelination, supporting a role for this molecule in MS pathogenesis. Two hundred and twenty-six patients with MS and 235 controls were genotyped for G  →  C and T  →  C single nucleotide polymorphisms (SNPs) in exon 4 of CXCL10 gene. Haplotypes were tested for association and correlated with clinical variables. The two SNPs studied were in complete linkage disequilibrium. None of the determined haplotypes was associated with MS. However, carriers of the GGTT haplotype (defined as wild type, according to the sequence in National Centre for Biotechnology Information (NCBI) database) had a significantly lower progression index than non-carriers ( P  = 0.016). Furthermore, amongst patients who had an initial relapsing remitting (RR) course of the disease, the time between onset and second episode was significantly longer in GGTT carriers ( P  = 0.021). Considering secondary progressive (SP)–MS patients, the time between the initial RR form and the subsequent worsening to SP was longer in this group ( P  = 0.08). Therefore, the GGTT haplotype of the CXCL10 gene is not a susceptibility factor for the development of MS, but is probably to influence the course of MS, possibly contributing to slow down the progression of the disease.     

建立具有中国特色的临床医学工程体系势在必行

我们提出了一个建立具有中国特色的临床医学工程体系新理念，并且提出了一些具体建设性的意见。它涉及到政府行政管理、医学院校教育、医院科室人员配置以及传统观念的管理模式等，由于理念新、涉及面广，会有许多问题，仅供各界人士共同去探讨。