我国乡镇卫生资源二次配置模式探讨

长期以来,我国卫生资源配置城乡不均衡的局面比较严峻,大量优质卫生资源主要积聚在大中城市,而乡镇基层医疗机构的卫生资源比较稀缺。以增加政府财政投入,引入私人资本与第三部门力量等方式来提高农村卫生资源增量势必会遇到投入缓慢、资金不足、技术瓶颈等现实障碍。通过改革公立医院,调整城市卫生资源存量,把大中城市公立医院中的富余卫生资源以二次配置方式转移到农村卫生服务机构,是破解农村卫生资源存量不足、增长缓慢的困境,提高农村卫生服务能力和水平,改善农民就医问药问题的新途径。     

红细胞体积分布宽度与冠心病关系的研究近况

红细胞体积分布宽度是血常规检测报告的一部分,临床多用于各种贫血的诊断与鉴别诊断。近年国内外研究显示,其测量值的增高与冠心病的死亡等不良事件发生风险增加密切相关。本文对其生物学特性与检测原理、与冠心病关系、测量值的增高预测冠心病不良预后的可能机制的研究进行综述。     

Display size effects in visual search: Analyses of reaction time distributions as mixtures

In a reanalysis of data from Cousineau and Shiffrin (2004) and two new visual search experiments, we used a likelihood ratio test to examine the full distributions of reaction time (RT) for evidence that the display size effect is a mixture-type effect that occurs on only a proportion of trials, leaving RT in the remaining trials unaffected, as is predicted by serial self-terminating search models. Experiment 1 was a reanalysis of Cousineau and Shiffrin's data, for which a mixture effect had previously been established by a bimodal distribution of RTs, and the results confirmed that the likelihood ratio test could also detect this mixture. Experiment 2 applied the likelihood ratio test within a more standard visual search task with a relatively easy target/distractor discrimination, and Experiment 3 applied it within a target identification search task within the same types of stimuli. Neither of these experiments provided any evidence for the mixture-type display size effect predicted by serial self-terminating search models. Overall, these results suggest that serial self-terminating search models may generally be applicable only with relatively difficult target/distractor discriminations, and then only for some participants. In addition, they further illustrate the utility of analysing full RT distributions in addition to mean RT.     

The elephant tied up with string: a clinical case study showing the importance of NHS provision of intensive,time-limited psychoanalytic psychotherapy treatments

Prof. Richard Layard's influential advocacy for greater provision of ‘evidence-based’ psychological therapies, based in part on an economic rationale, has lead to greatly increased provision of cognitive behavioural therapy (CBT) and short-term therapies for depression, through the Increasing Access to Psychological Therapies (IAPT) initiative, whilst longer-term psychodynamic treatments are under threat, criticised as lacking an evidence base. This paper argues for the continuing provision of intensive thrice-weekly psychoanalytic psychotherapy treatments, time-limited to two years. It does so by describing such a treatment within an NHS psychotherapy department with a patient with a long history of severe personality pathology, including significant levels of perversity. The paper describes the patient's difficulties and his movement through the treatment, focussing on his difficulties making genuine emotional contact, his destructiveness of such contact, his acting out in the treatment, his perversity and the vital working through of the ending. The shifts the patient made are described, and follow-up information on the patient is given. The paper discusses the unique benefits of time-limited treatment and intensive psychoanalytic treatments for this ‘hard-to-help’ group of patients, and the economic rationale that can be made for such treatments.     

Treatment of Adolescent Panic Disorder: A Nonrandomized Comparison of Intensive Versus Weekly CBT

This study compared the relative efficacy of intensive versus weekly panic control treatment (PCT) for adolescent panic disorder with agoraphobia (PDA). Twenty-six adolescents participated in weekly sessions and 25 received intensive treatment involving daily sessions. Both groups demonstrated significant and comparable reductions in panic disorder severity and general anxiety symptoms, which maintained over time. Participants receiving weekly treatment showed significant decreases in depressive symptoms, whereas those in the intensive program reported no change. Findings support the efficacy of the intensive approach for adolescent PDA, but suggest that adolescents receiving intensive treatment may benefit from a brief course of additional weekly sessions.     

ICU成人患者镇痛药物的使用：阿片类及其他

ICU患者经历着各种各样的疼痛,镇痛治疗对于ICU患者至关重要.目前可用于ICU成年患者的镇痛药物很多,主要有阿片类镇痛药、解热镇痛抗炎药和对某些特殊疼痛状态有效的药物.阿片类药物仍是非神经性疼痛的一线用药,使用最多的是阿片受体激动药,包括吗啡、芬太尼、舒芬太尼、瑞芬太尼等,其中舒芬太尼、瑞芬太尼在国内ICU中使用经验不多;阿片受体部分激动药在国内ICU使用很少,包括喷他佐辛、地佐辛等;非甾体类镇痛药在国内ICU使用也很少,包括氟比洛芬酯、帕瑞昔布等.本文旨在简单介绍舒芬太尼、瑞芬太尼、部分阿片受体激动剂及非甾体类镇痛药在ICU的应用.     

A Bayesian psychophysical model for angular variables

Bayesian theories of perception provide a link between observed response distributions and theoretical constructs from Bayesian decision theory. Using Bayesian psychophysics we derive response distributions for two cases, one based on a normal distribution and one on a von Mises distribution for angular variables. Interestingly, where the theoretical response distribution is always unimodal in the case of normal distributions, it can become bimodal in the angular setting in the case when prior and likelihood are about equally strong.     

对心血管病临床强化治疗的质疑

强化治疗是最近几年反复提到的话题。很多临床试验研究各种强化治疗对心血管疾病预后的影响,但结果显示强化治疗并未能带来更多的益处,甚至有害。因此我们必须理性地看待这些所谓的强化治疗。更应该倾向于个体化治疗、综合治疗,包括控制各种危险因素,改善生活的方式。把治疗的眼光放到疾病发生的早期,早治疗,以求更多获益。     

Simple use of BIC to Assess Model Selection Uncertainty: An Illustration using Mediation and Moderation Models

Abstract

The Bayesian information criterion (BIC) has been used sometimes in SEM, even adopting a frequentist approach. Using simple mediation and moderation models as examples, we form posterior probability distribution via using BIC, which we call the BIC posterior, to assess model selection uncertainty of a finite number of models. This is simple but rarely used. The posterior probability distribution can be used to form a credibility set of models and to incorporate prior probabilities for model comparisons and selections. This was validated by a large scale simulation and results showed that the approximation via the BIC posterior is very good except when both the sample sizes and magnitude of parameters are small. We applied the BIC posterior to a real data set, and it has the advantages of flexibility in incorporating prior, addressing overfitting problems, and giving a full picture of posterior distribution to assess model selection uncertainty.