医疗保险基本药物招标采购模式的实现途径探讨

目的：围绕酝酿中的上海市“医保药品招标采购模式”,探讨其理论基础及实施途径。方法：专家访谈与理论分析。结果：提出以药品使用后利润率返还为特点的支付者模式,旨在短期内降低原研药、独家品种价格;以医保基金作为招标和采购唯一主体的购买者模式,旨在从根本上实现“医药分离”和采购“量价挂钩”。结论：两种模式各有优势劣势,应通过建立综合性药品采购信息平台,并在此基础上按消费量进行药品采购分类与集中购买试点等途径逐步建立医保基金药品购买模式。     

县级公立医院长效补偿机制的内容——县级公立医院补偿机制改革研究(四)

构建长效补偿机制是县级公立医院补偿机制改革的根本目标。对公立医院长效补偿机制的内容应该从补偿主体、补偿对象、补偿数量、补偿方式、补偿功能五个方面予以界定。补偿主体是指"谁补偿"公立医院的问题,补偿对象是指对公立医院"补偿什么"的问题,补偿数量是指对公立医院"补偿多少"的问题,补偿方式是指对公立医院"如何补偿"的问题,补偿功能是指对公立医院"为何补偿"的问题。正确解答这些问题,才能建构科学的县级公立医院长效补偿机制。     

疾病编码主体的探讨

ICD是一门科学性、技术性、专业性很强的疾病分类方法,具有自身的系统性、复杂性及标准化的操作规程。疾病编码主体必须是专业的编码员,临床医师的责任是准确、完整、规范地书写诊断。保证高质量的编码,应让编码员与临床医师各司其职,各有侧重,并建立有效的沟通机制。     

浅谈本科毕业论文专题的探索与实践

从高等学校开展毕业专题的现状和存在的问题出发,分析了在本科教育中开展此项工作的瓶颈所在,提出了"政策为前提,教师为导体,学生为主体,实验为载体"的观点,并结合自身在泰山医学院药学院毕业专题中的切身实践,从政策引导、制度建设、教学实践、师资管理等方面就如何更好地开展此项工作提出了有益的建议,以供同类院校交流与参考。     

Influences of body posture on duration of oral swallowing in normal young adults

The primary purpose of this study was to determine whether body posture altered the duration of oral swallowing. To answer this question, we recorded electromyograms (EMGs) from the anterior tongue and suprahyoid (SH) muscles as well as laryngeal movement associated with swallowing in nine normal young subjects. The subjects swallowed a test food after receiving a signal while in four randomly set postures: upright, two inclined (60 degrees and 30 degrees to the horizontal), and supine positions. We measured the durations from the start to the peak and from the peak to the end of the integrated tongue and SH EMGs. We assumed that the duration from the start to the peak of the integrated SH EMG would correspond to the duration of oral swallowing. The average duration from the start to the peak of the integrated SH EMG decreased after moving from the upright to the inclined and supine positions. The decrease in the duration was statistically significant and consistent for three experimental sessions. The duration from the start to the peak of the integrated tongue EMG during swallowing tended to decrease after lying down, but not significantly. The postural changes did not affect the remaining four durations. The decrease in the duration of oral swallowing induced by lying down suggests that the gravitational force placed on the test food facilitates the swallowing reflex. Large variation in the tongue activity during swallowing among the subjects can probably be attributed to the lack of a significant decrease in the duration of the tongue activity.     

Performance of intraclass correlation coefficient (ICC) as a reliability index under various distributions in scale reliability studies

Many published scale validation studies determine inter‐rater reliability using the intra‐class correlation coefficient (ICC). However, the use of this statistic must consider its advantages, limitations, and applicability. This paper evaluates how interaction of subject distribution, sample size, and levels of rater disagreement affects ICC and provides an approach for obtaining relevant ICC estimates under suboptimal conditions. Simulation results suggest that for a fixed number of subjects, ICC from the convex distribution is smaller than ICC for the uniform distribution, which in turn is smaller than ICC for the concave distribution. The variance component estimates also show that the dissimilarity of ICC among distributions is attributed to the study design (ie, distribution of subjects) component of subject variability and not the scale quality component of rater error variability. The dependency of ICC on the distribution of subjects makes it difficult to compare results across reliability studies. Hence, it is proposed that reliability studies should be designed using a uniform distribution of subjects because of the standardization it provides for representing objective disagreement. In the absence of uniform distribution, a sampling method is proposed to reduce the non‐uniformity. In addition, as expected, high levels of disagreement result in low ICC, and when the type of distribution is fixed, any increase in the number of subjects beyond a moderately large specification such as n = 80 does not have a major impact on ICC.     

Planning strategies for the avoidance of pitfalls in intervention research

BACKGROUND: With the exception of large clinical trials, few studies in nursing and other social sciences test interventions. The discipline of nursing needs to maintain a full range of research designs for continued knowledge development. Intervention research presents unique opportunities and challenges for the novice as well as the seasoned researcher. Some of these methodological challenges include the complex nature of human subjects and interventions, including many factors that interfere with the study variables. Preliminary studies often reveal challenges that may not always be predicted or reflected in research texts. These challenges may be as important as the study results for success in future research efforts. PURPOSE: Difficulties encountered in intervention research and suggested strategies for maintaining the integrity of the study are addressed. These challenges include maintaining an adequate sample size, intervention demands, measuring variables, timing issues, and experiencing unexpected events. FINDINGS AND CONCLUSIONS: Strategies presented include the importance of extensive planning, minimizing subject expectations and rewarding efforts, attention to control group members, incorporating retention strategies, expanding knowledge of variables and the study population, preliminary studies as well as anticipating unexpected events. The need for enhanced communication among nurse researchers, educators and clinicians is addressed. In the current health care arena, nurse researchers must understand organizational dynamics and marketing strategies. Collaborative research efforts can increase the visibility of nursing research as well as funding opportunities.     

对护理专业学生实施人文教育的思考

目的探索护理专业学生人文教育的实质及人文精神的培养方法。方法采用文献研究分析法。结果将护理专业学生人文教育定位于“成人”教育，界定在人性教育，其核心是涵养人文精神，人文教育的核心学科为哲学、文学、历史和艺术。结论人文教育的定位、界定和对核心学科的充分认识能够帮助护理教育者充分认识人文教育的本质和方法，有利于护理学科的建设、发展和培养科学素养兼具人文精神的高级护理人才。     

临床药师干预对抗肿瘤药物临床试验方案偏离的影响简

目的：探讨临床药师加入抗肿瘤药物临床试验后对方案偏离发生率的影响。方法：选取江苏省肿瘤医院2011年9月至2013年2月参与抗肿瘤药物临床试验的受试者,分为未干预组和干预组。未干预组为2011年9月至2012年5月在研的受试者,干预组为2012年6月至2013年2月在研的受试者,分别统计两组受试者临床试验方案偏离发生的种类及发生率,观察临床药师干预对临床试验方案偏离的影响。结果：未干预组与干预组受试者方案偏离发生率之间的差异具有统计学意义（61．3％V843．9％,P〈0．05）,两组之间严重方案偏离发生率的差异也具有统计学意义（37．3％VS19．7％,P〈0．05）。结论：临床药师参与抗肿瘤药物临床试验,可降低受试者方案偏离的发生率,为临床药师在肿瘤内科开展工作提供了新的契机。     

Bootstrap analysis of the single subject with event related potentials

Neural correlates of cognitive states in event-related potentials (ERPs) serve as markers for related cerebral processes. Although these are usually evaluated in subject groups, the ability to evaluate such markers statistically in single subjects is essential for case studies in neuropsychology. Here we investigated the use of a simple test based on nonparametric bootstrap confidence intervals for this purpose, by evaluating three different ERP phenomena: the face-selectivity of the N170, error-related negativity, and the P3 component in a Posner cueing paradigm. In each case, we compare single-subject analysis with statistical significance determined using bootstrap to conventional group analysis using analysis of variance (ANOVA). We found that the proportion of subjects who show a significant effect at the individual level based on bootstrap varied, being greatest for the N170 and least for the P3. Furthermore, it correlated with significance at the group level. We conclude that the bootstrap methodology can be a viable option for interpreting single-case ERP amplitude effects in the right setting, probably with well-defined stereotyped peaks that show robust differences at the group level, which may be more characteristic of early sensory components than late cognitive effects.