Combining Patient Utility with Health Status Assessment to Improve Medical Decision Making

Physicians often use health status assessment tools to evaluate a patient's condition, then apply established guidelines to determine the most medically effective treatment. Yet additional criteria, such as the appropriateness of the treatment given the particular patient's preferences and attitude toward risk, are also highly relevant to quality care. While such preferences could be addressed via patient utility functions, their use in actual practice is somewhat limited because elicitation is often considered too burdensome for patients, unreliable, or redundant given other measures. For a small group of real patients who have suffered a stroke, we measure both traditional health status and patient utility for the current state to determine whether limited, focused utility assessment is a practical means of obtaining additional and relevant patient information. We find that utility assessment is perceived as reasonable and useful by patients, even when quite ill, and that utilities and health status are not redundant. In fact, investigating apparent inconsistencies between patient utility and observed health status can alert the physician to patient concerns and criteria not captured by more traditional measures. We propose an approach to medical decision making that uses both measures to improve patient–physician communication.     

The operation of Lake Kariba: A multiobjective decision analysis

The paper describes a successful application of Bayesian decision analysis to the operation of the Lake Kariba hydropower system. This management problem is complicated by the high uncertainty of the inflow process, multiple and conflicting objectives and the influence of time on some of the parameters in the management task. Inflows to the reservoir are forecast through dynamic linear models. Managerial preferences are modelled through a multiattribute utility function. Since the solution of the exact model is computationally too demanding, a heuristic method is applied to find a feasible control strategy. A comparison with results obtained by methods used previously demonstrates the superiority of the methodology presented here.     

An approach to and computational results on testing the form of a decision maker's utility function

In this paper we consider the problem of identifying the form of a decision maker's (DM) utility function. We consider a set of alternatives each defined by a number of criteria and we assume that the DM's preferences are consistent with some underlying utility function. We present some theory and develop approaches to test whether the DM's preferences are consistent with a linear, a quasi-concave, a quasi-convex or a general monotonic function. We present our computational experience showing that in almost all cases the approaches correctly identify the form of the underlying utility function and require very little preference information of the DM.     

论合理功利意识下的奉献精神——新世纪革命军人奉献观探究

把祖国、人民的利益视作高于一切,为了它甘愿献出自己的全部,甚至不惜牺牲生命的奉献精神是每一名革命军人所应有的品质。但是,随着改革开放的深化、市场经济的发展和价值观念的转换,这种奉献精神逐渐被赋予了新的时代内涵。正确认识并合理分析反映现代市场经济关系的合理功利意识下的奉献精神,不仅是新世纪继承与弘扬革命军人奉献精神的需要,更是推进我军现代化建设、实现我军思想政治工作创新发展的需要。     

艾滋病传播的调查与质性研究——以一个西北少数民族聚居地区为例

运用民族学学科“田野调查”的方法,展开对甘肃省LX州的一个西北少数民族聚居镇——A镇,艾滋病传播的实证研究。论文首先探讨了A镇艾滋病传播的背景与途径;试图从这些访谈实例中,探讨这些艾滋病病毒感染者HIV和艾滋病病人AIDS及其家属面对艾滋病传播的不同文化适应,总结与概括A镇艾滋病传播与社会、文化、经济等因素之间的内在关联与影响。     

美沙酮维持治疗者社会网络的现状分析及对策——基于无锡市吸毒者的医学社会学研究

通过社会流行病学调查,对受艾滋病和社会歧视双重威胁的关沙酮维持治疗者的社会交往和社会支持网络的构成、特征进行分析;表明该群体的社会交往网络局限于非正式群体;而社会支持网中的正式群体对其回归社会起关键作用;因而完善其家庭和社会功能恢复的途径,对我国禁毒工作和遏制艾滋病传播尤为重要。     

关于手术戒毒规范化开展的思考

吸毒成瘾是严重的医学和社会学问题。国内、外对吸毒成瘾采取的治疗方案由脱毒、防复吸和回归社会三个相互关联的方法构成。但收效甚微,复吸率居高不下。西安第四军医大学唐都医院神经外科在动物实验和借鉴以往经验的基础上,将立体定向技术用于毁损脑内与毒品心理依赖密切相关的关键位点的异常部分,对其异常功能进行调整,从而达到彻底戒毒的目的,取得了良好的疗效。本文介绍了手术戒毒在我国的发展历史,提出了规范化开展手术戒毒的建议。     

药物不良反应侵权诉讼问题研究

药物不良反应侵权诉讼是一种特殊的民事侵权诉讼。药品的生产者、药品经营者以及医疗机构都可能成为诉讼中的被告。药物不良反应侵权诉讼中的许多案件事实实行举证倒置。主要举证倒置事实有:药品缺陷、因果关系、免责事由、医疗过错等。     

Police interviewing and psychological vulnerabilities: predicting the likelihood of a confession

This paper is concerned with examining the differences between people who confess and those who deny offences during a police interview. The main hypothesis under investigation is that psychologically vulnerable suspects are particularly likely to confess. This paper is also concerned with identifying variables that might be related to the confession process. One hundred and sixty suspects detained at two London police stations were assessed psychologically prior to being interviewed by the police. The results of this assessment, an analysis of the interview procedure and biographic details were subjected to a logistic regression analysis. There was no evidence to support our main hypothesis. However, suspects were more likely to confess if they reported having consumed an illicit (non-prescribed) drug in the previous 24-hour period, and less likely to confess when interviewed in the presence of a legal adviser or if they had experience of prison or custodial remand. In this study younger suspects were also more likely to confess. © 1998 John Wiley & Sons, Ltd.