医患共同决策诊疗模式的现状分析

医患共同决策诊疗模式已经践行了许多年.系统检测,卓有成效.但是,在实践过程中仍然有很多问题存在.尽管许多医生认为自己已经使用了共同决策,但是研究显示出现实与感知的差异.由于我们的决策面对的是需要治疗的患者,而患者是存在个体差异的;同时,医学知识和技术是在不断发展和进步的,所以医生需要改变传统的决策方式,重视医学证据、可用资源和患者的价值取向.     

个体化喉部分切除术的思考

喉癌以手术为主要治疗方式,在现代功能性外科治疗理念的指导下,个体化喉部分切除术已被提出并逐渐推广应用,本文就这一术式展开哲学思考,认为个体化喉部分切除术提出及应用中遵循的哲学规律包括:矛盾对立统一规律;矛盾普遍性与特殊性规律;主要矛盾与次要矛盾关系的规律.     

关注肿瘤患者避免过度诊疗——解析ASCO大会关于肿瘤诊疗的5项建议

现代肿瘤的诊疗水平已经有了长足的进步,先进的诊断技术使得很多肿瘤得以早期发现并积极治疗,很多晚期患者也不再面临无药可用的境地,但由于临床医生的认识存在偏差,存在过度诊断和过度治疗的问题,进而给患者带来不必要的负担和痛苦。美国临床肿瘤学会（ASC0）年会上发布了一篇名为“ASCO为改善肿瘤治疗质量及医疗花费的5项建议”的文章,特别提出要重视五项临床广泛应用、花费较大,但缺乏高级临床证据的肿瘤治疗或干预措施,也提示我们需要充分评估,综合思考,为合适的患者提供正确的诊治方案,才能给患者带来更大的获益。     

胃肠道肿瘤的分子靶向治疗:未来的方向?

分子靶向治疗是这几年来消化道肿瘤治疗领域的热门话题.这类新一代的分子靶向生物治疗模式,将在临床治疗肿瘤实践中具有广阔的应用前景.从事肿瘤研究的临床医务人员需要综合归纳这些信息,融汇入自己的认知将之合理应用于患者.我们将真正进入传统的细胞毒性药物攻击与非细胞毒性靶向性药物相结合使用的时代,真正实现延长患者的生命,改善其生活质量的目标.     

糖尿病与乳腺癌关系研究进展

近年来随着生活水平的提高,饮食结构的改变,糖尿病的发病率不断升高,其并发症严重危害人们的健康.对于女性来说,乳腺癌发病率已上升为危害女性健康的首位恶性肿瘤,给女性带来了严重的心理压力.糖尿病与癌症相关性研究逐渐引起重视.有研究表明,糖尿病会增加乳腺癌的发病率,但也有研究表明二者之间的关系存在争议,所以需要进一步的流行病学调查研究.本文对近年来关于糖尿病与乳腺癌关系的流行病学调查以及糖尿病与乳腺癌之间可能的作用机制作一综述.     

间隔时间及记忆负荷对信息缺失错误记忆的影响

现场中的信息缺失会影响人类对事件的记忆,这对证人证言研究是非常重要的,但以往对之却鲜有研究.本研究以大学生为被试,运用信息缺失范式,采用视频录像材料,通过2个实验探讨了间隔时间和记忆负荷对错误记忆的影响.结果表明:(1)间隔时间没有影响真实记忆和错误记忆,但信心水平却随着间隔时间的延长而变化;(2)记忆负荷高低没有影响真实记忆却影响了错误记忆,在关键信息呈现条件下,降低记忆负荷可以减少错误记忆的发生;(3)信息性质会影响人们的记忆,关键信息呈现条件下的错误记忆和真实记忆均高于关键信息缺失的条件.     

The Role of Sketching States in the Stimulation of Idea Generation: An Eye Movement Study

Sketching is widely used in design to generate creative ideas. Design studies present stimuli during sketching to enhance creativity. This study examines the effect of stimuli presented during different sketching states, especially of those presented during the stuck period. It conducted a sketching experiment that enrolled 41 students with an average of 5.7 years’ practice in industrial design. The sketching with stimuli presented at regular intervals, those with stimuli presented during the stuck period, and those without stimulus were compared. Eye movements during the sketching processes were recorded. The attention to stimuli, and the direct applications of stimuli to design ideas, and the idea connection and idea differentiation were analyzed. Participants sketching with stimuli presented during the stuck period had a higher sketching quality, compared with those in other experimental conditions. They fixated longer on stimuli, built more links among related ideas, and had a more differentiated and balanced exploration. This study then proposed the mechanisms of stimuli processing. The stimuli presented at regular intervals were stored and acted as additional memory. The stimuli presented during the stuck period were dissected and acted as supporter, inducing a more creative sketching.     

Knowledge and economic growth—creativity,learning and knowledge utilization

The purpose of this study is to discuss the dynamic interdependence of knowledge and economic growth. We show that the traditional economics, which treats knowledge as parameters and is mainly developed within linearized, stable and static frameworks can hardly explain the modern economic complexity. We argue that it is necessary to treat creativity, learning and knowledge utilization as endogenous dynamic processes of social and economic evolution. To handle with the complicated dynamic interdependence of wealth and knowledge accumulation, we need to apply genuine nonlinear dynamic theory. In particular, we discuss possible benefits of government's intervention in education and science to the society when the social and economic evolution is characterized of nonlinearity, instability and multi‐equilibria.     

A Computationally Efficient State Space Approach to Estimating Multilevel Regression Models and Multilevel Confirmatory Factor Models

Although the state space approach for estimating multilevel regression models has been well established for decades in the time series literature, it does not receive much attention from educational and psychological researchers. In this article, we (a) introduce the state space approach for estimating multilevel regression models and (b) extend the state space approach for estimating multilevel factor models. A brief outline of the state space formulation is provided and then state space forms for univariate and multivariate multilevel regression models, and a multilevel confirmatory factor model, are illustrated. The utility of the state space approach is demonstrated with either a simulated or real example for each multilevel model. It is concluded that the results from the state space approach are essentially identical to those from specialized multilevel regression modeling and structural equation modeling software. More importantly, the state space approach offers researchers a computationally more efficient alternative to fit multilevel regression models with a large number of Level 1 units within each Level 2 unit or a large number of observations on each subject in a longitudinal study.     

Sensitivity of Fit Indices to Misspecification in Growth Curve Models

This study investigated the sensitivity of fit indices to model misspecification in within-individual covariance structure, between-individual covariance structure, and marginal mean structure in growth curve models. Five commonly used fit indices were examined, including the likelihood ratio test statistic, root mean square error of approximation, standardized root mean square residual, comparative fit index, and Tucker-Lewis Index. The fit indices were found to have differential sensitivity to different types of misspecification in either the mean or covariance structures with severity of misspecification controlled. No fit index was always more (or less) sensitive to misspecification in the marginal mean structure relative to those in the covariance structure. Specifying the covariance structure to be saturated can substantially improve the sensitivity of fit indices to misspecification in the marginal mean structure; this result might help identify the sources of specification error in a growth curve model. An empirical example of children's growth in math achievement (Wu, West, &; Hughes, 2008 Wu, W., West, S. G. and Hughes, J. N. 2008. Effect of retention in first grade on children's achievement trajectories over four years: A piecewise growth analysis using propensity score matching.. Journal of Educational Psychology, 100: 727–740. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) was used to illustrate the results.