乙肝防治决策的基本点

我国现有乙肝现症感染者1亿多人,乙肝防治决策需要整个社会的参与,决策是否可以取得成效取决于以下几个基本点:决策的权威性;决策的科学性;决策的可行性.决策的前提是:预防为主,治疗为辅.     

乙肝抗病毒治疗存在的问题及其对策

对乙肝的治疗,抗病毒是核心和关键,但抗病毒治疗自身存在着诸多问题:费用高、疗程长、疗效有限、治疗时机和条件难以掌控;药物有潜在或者明确的不良反应;医患认知不足;疗效评价极端化;治疗中不可预测因素的干扰等。通过细致的分析,探讨了乙肝治疗中的难点,并针对这些问题和难点就未来乙肝的治疗提出了一些有益的建议。     

乙肝抗病毒治疗存在的问题及其对策

对乙肝的治疗,抗病毒是核心和关键,但抗病毒治疗自身存在着诸多问题:费用高、疗程长、疗效有限、治疗时机和条件难以掌控;药物有潜在或者明确的不良反应;医患认知不足;疗效评价极端化;治疗中不可预测因素的干扰等.通过细致的分析,探讨了乙肝治疗中的难点,并针对这些问题和难点就未来乙肝的治疗提出了一些有益的建议.     

第一讲 临床决策分析概述

为了使大家对临床决策有更加深入的理解,本刊编辑部特约请上海交通大学上海市第六人民医院曹建文副教授就临床决策的相关问题撰写了系列讲座,讲座的内容为:第一讲:临床决策分析概述;第二讲:如何构建不确定条件下的临床决策;第三讲:临床决策分析中如何应用决策树;第四讲:临床决策分析中的效用分析;第五讲:灵敏度分析在临床决策中的应用;第六讲:临床诊治中的Markov模型;第七讲:成本-效果分析在临床决策中的作用;第八讲:决策分析在药物经济学中的应用。我们希望读者看过这些讲座后,踊跃提出问题,发表意见,以促进医疗决策的深入研究。     

2型糖尿病与乙肝肝硬化相关原发性肝癌的关系

为了探讨在乙肝肝硬化患者中,2型糖尿病与原发性肝癌之间的关系,回顾性分析2010年1月~2015年5月于辽宁医学院附属第一医院收治的733例乙肝肝硬化患者的相关临床资料。结果提示:糖尿病及HBV-DNA阳性是乙肝肝硬化患者发生原发性肝癌的危险因素(OR值分别为2.650、23.982,P值均0.05),且糖尿病病程越长,发生原发性肝癌危险性越高(糖尿病病程于5年~10年者,其OR值为9.232;大于10年者,OR值为12.925);乙肝肝硬化合并糖尿病患者,原发性肝癌的发生与糖尿病治疗方案无关(P0.05);高胰岛素血症及胰岛素抵抗是乙肝肝硬化患者发展为原发性肝癌的危险因素(P0.05)。     

临床决策论坛版征文重点

临床决策论坛版近期拟以下内容为重点:1.临床决策的宏观论述。临床决策的绩效评述;临床决策与政策环境;临床决策与舆论导向;如何看待临床决策的失误;病人经济情况的临床决策;医师法与临床决策;临床组织决策。此类文章在临床决策研究栏发表。欢迎大家就临床决策中的各种问题进行     

优化乙肝治疗方案真实评价治疗效果

目前乙肝治疗比较混乱,给患者带来许多损失,优化乙肝治疗方案,是从患者病情出发,实施个体化治疗,目标是安全、有效、经济和适度,处于抗病毒最佳时机的患者可以考虑使用干扰素或拉米夫定;乙肝病毒携带者暂时禁止使用药物治疗;急性乙肝只给与基本治疗,待其自愈.实施优化方案,杜绝各种各样的商业广告;凡是尝试性治疗,一律按照新药临床验证程序进行,一律实行免费.治疗乙肝的疗效最终取决于持久、完全效应,不应局限在病毒阴转或肝功正常上.     

临床决策论坛版征文重点

临床决策论坛版近期拟以下内容为重点:1.临床决策的宏观论述。临床决策的绩效评述;临床决策与政策环境;临床决策与舆论导向;如何看待临床决策的失误;病人经济情况的临床决策;医师法与临床决策;临床组织决策。此类文章在临床决策研究栏发表。欢迎大家就临床决策中的各种问题进行     

临床决策论坛版征文重点

临床决策论坛版近期拟以下内容为重点:1.临床决策的宏观论述。临床决策的绩效评述;临床决策与政策环境;临床决策与舆论导向;如何看待临床决策的失误;病人经济情况的临床决策;医师法与临床决策;临床组织决策。此类文章在临床决策研究栏发表。欢迎大家就临床决策中的各种问题进行广泛的讨论。字数不限。可从自身临床实践中的感触谈起,也可就国外此方面的情况进行介绍和评述。欢迎临床医师动笔,也欢迎业外人士发表意见。2.当前临床决策中一些普遍关心的热点问题的研究和讨论:(1)支架的放置。在冠心病治疗中如何看待介入治疗(PTCA)的适应证的…     

浅谈影像医学实习生医学伦理决策能力的教育培养问题

医学伦理决策能力是影像医学实习生教育培养的重要组成部分,加强医学伦理决策能力的教育培养是十分必要的。阐述了医学伦理决策能力教育培养的目的、目标和内容,内容是:深刻认识医学伦理决策能力的作用;医学影像检查诊断所涉及的医学伦理问题;医学伦理决策的基本程序。医学伦理决策能力教育培养的基本路径和方法主要是:启发实习生查找和发现医学伦理问题;开展死亡、疑难危重病历和正反医学案例的医学伦理分析、判断;开展医学伦理决策能力的专题讲座;医学伦理决策模拟训练等。     

对影响“临床决策”负面因素的剖析与探讨

临床决策是医疗实践过程中的中心环节,直接关系到病人的治疗效果。在决策形成和实施过程中受到各方面因素的制约,主要包括两个方面医生自身方面因素,如医生素质、技术水平、决策思维能力等;医生自身以外的因素,如卫生政策、药品及其它医疗器材的流通环节、医保制度、医院经营方针,其它因素如社会、伦理、法律、经济等无不影响着医疗决策的正确实施。因此,要排除干扰,努力实施科学的临床决策,不仅要加强医生本身的素质和技术层面的培养和提高,更需要全社会、患者和广大公众给予理解和支持。     

Bailing and jailing the fast and frugal way

Legal decisions such as the decision to bail upon adjourning a case have major consequences for both defendants and society. In the English system, magistrates, most of whom are lay people, are afforded considerable discretion and must work under constraints such as time pressure. Judgment analysis of the bail decision making policies of 81 magistrates from 44 courts throughout England and Wales revealed intra‐ and inter‐magistrate inconsistency in bail decisions, discrepancies between stated and elicited cue use, and high levels of post‐decisional confidence. Furthermore, magistrates' policies were better described and predicted by a fast and frugal model characterized by noncompensatory cue use, than by either of two compensatory integration models. The fast and frugal model portrays a picture of bail decision making that conflicts with the ideal practice as defined by the due process model of justice. We discuss the implications of these findings for judgment and decision making research and criminal justice policy. Copyright © 2001 John Wiley & Sons, Ltd.     

临床决策与卫生政策

从讨论趋利性临床决策与泛企业化卫生政策的共同作用是造成我国医改失败的根本原因入手,在对3个典型案例进行深入剖析的基础上,论证了临床决策和卫生政策相互依存、相互作用的基本关系;研究了临床决策与卫生政策的决策主体、影响因素、决策过程、信息反馈、关系调整的循环路径;认为完善决策机制是保证临床决策和卫生政策正确有效的必要条件,提出了进一步完善临床决策和卫生政策的决策机制的具体意见和建议。     

Can perceptions of similarity reduce the ability to see the other’s needs? The case of immigrant students’ integration policy

In this age of wide migration waves all over the world, when schools’ populations become more diverse, educators often make policies regarding groups of immigrant students (from the same origin) with unique needs. Perceptions of homogeneity of the group, as well as perceptions of similarity between the decision maker and the group members are likely to have a major influence on these policies. Although research has shown that perceptions of great similarity between the decision maker and a target group enhance empathy and promote decisions in favor of the group; results of the current research, examining immigrant students’ integration policy in schools, suggest that inaccurate high similarity perceptions (on a relevant domain) might decrease the ability to understand the targets’ diverse needs and may lead to decisions that do not serve the group, or the decision maker’s goals. Two studies were conducted to examine the effect of perceived homogeneity and similarity on immigrant integration policy in schools. In the first study, lay people recommended fewer programs for immigrants students when those where judged to be more similar to themselves and more homogenous. Similar results were obtained in the second study, examining school principals’ reports of existing programs for immigrant students in their schools. Implications on policy making are discussed.     

基于助推的健康饮食行为干预策略

在干预国民健康饮食行为方面, 更“隐性”的助推策略因其针对直觉思维系统发挥作用, 比传统的干预政策更具优势。基于助推策略对食物选择决策影响机制的不同, 健康饮食助推策略可构建为提供决策信息、改善决策选项、影响决策结构和提醒决策方向4个大类及9个小类的框架体系。助推策略在实践中仍存在争议, 因而在中国实施时需与传统政策结合使用, 充分考虑中国国情和消费群体特征, 并充分利用信息技术和大数据优势, 助力健康中国。     

Letter to the editor,Schools on Islands,a journal as a Ferry

In an electronic brainstorming session, experts and users of methods for multi-criteria decision analysis discussed editorial policies for a journal which is confronted with the conflicts between isolated schools of thought. The present paper describes the session and highlights how experts in multi-criteria decision analysis view the applications of their own methods on their own decision problems.     

Decision versus policy in crises intervention

The paper describes procedures for contrasting actions taken by crises intervention outreach workers and consumers with administrative policies. The data used to exemplify the procedures came from the outreach projects of six county MH/MR programs in Central Pennsylvania during the year following the flood caused by Hurricane Agnes, in 1972. The procedure identifies and counts the ways through which consumers entered the outreach process; the major outreach worker decision; and the immediate disposition of each consumer's case. The six county MH/MR program administrators were asked to consider program policies and show how they would ideally expect 1,000 hypothetical consumers to come into, to be processed through, and to be referred out of their respective outreach programs. Contrasts of the ideal and actual consumer data, along with consumer follow-up questionnaires, provided the basis for evaluating the six county MH/MR program outreach projects. These experiences provided the basis for a generalized model of evaluating crises intervention activities.     

Pesticides and Policies

ABSTRACT The decision to accept or to reject an empirical hypothesis concerning the risks and hazards of a pesticide requires assessing the cost's of error if the wrong decision is taken. The assessment of such costs involves scientists in problems which are closely related to those which policy-makers face in deciding what to do in view of the information provided by scientists. These problems include the unforeseeable effects of agricultural technologies, the assessments of costs and benefits, and the choice of decision rule to use in policy formation. I conclude that the combined impact of these problems motivates the use of prudentially weighted decision rules in forming policies which regulate the use of pesticides, and it motivates the development of bio-environmental alternatives to chemically based pest control policies.     

Criticisms of the criminal justice system: A decision making analysis

When a decision making analysis is applied to key decisions within the criminal justice system, e.g., bail, sentencing, and plea bargaining, a wide range of evidence suggests that the decision makers believe they follow policies other than those that actually guide their decisions; that the policies that are followed are often simple ones, involving only a few decision factors; and that the decision outcomes are often assigned to defendants in a reasonable manner but that, even so, the outcomes are often ineffective. Because many proposals for the reform of the criminal justice system are based on the testimony of decision makers and “experts” whose knowledge of the system is often flawed, it is unlikely that reforms will have a beneficial impact on criminal behavior until much more is known about the day-to-day decisions of judges, prosecutors, and probation officers.     

Information search in decisions from experience. Do our patterns of sampling foreshadow our decisions?

Do different patterns of sampling influence the decisions people make, even when the information the decisions are based on is equivalent? Do more and less switching between options correlate with different kinds of decision policies? In past research, the correspondence between search and decision patterns has been difficult to ascertain because the information obtained has often been confounded with its consequences in an exploration-exploitation trade-off. We used a sampling task in which information is explored prior to being exploited. We found that search patterns did reveal decision policies. Individuals who transitioned more frequently between options were more likely to choose options that win most of the time in round-wise comparisons and were more likely to underweight rare, risky events. Less switching between options was associated with choosing options that win in the long run on the basis of summary comparisons--decisions consistent with expected-value maximization and linear weighting of outcomes.