论道教“祝由符咒”的实用价值及其对中医“意疗”的影响

道教“祝由符咒”起源于巫术,后世用以为人治病时,又体现出一定的实用价值。中医学受其启发,以祝由之术治疗情志疾病,其疗效受到历代医家推崇,由此丰富和发展了中医学的治疗方法。     

文化自信视域下中医药现代价值与发展定位探析

新冠肺炎疫情暴发以来,中医药广泛介入且疗效显著,引发学术界、媒体、民众对中医药现代价值和发展状况的思考与讨论。结合文化自信的战略视角,可从以下三个维度分析其价值与定位:从文化传承角度看,弘扬中医药文化是打开中华文明宝库的重要门户,中医药文化的承续与推广,是中华文明复兴的开路先锋;从文化创新角度讲,推动中医药与现代科技、文化的对接、融合,强化其作为连接传统文化与现实生活的纽带作用,有助于建立以健康实践为旨归的中国文化新体系;从文化传播布局言,宣传中医药文化是为世界卫生发展贡献中国智慧、提供中国方案,以中医药文化作为传播中华文化的先行军必将大有可为。     

中药组合物发明的创造性问题研究

针对中药组合物发明的创造性判断问题以及中药组合物发明的创造性与中药药理之间的关系问题展开研究。如果中药组合物发明是中医药领域的技术人员在现有的中药处方的基础上,仅仅根据已知的中药药理进行合乎逻辑的分析、推理或者有限的试验就可以得到,且没有产生预料不到的技术效果,则该中药组合物发明不具备创造性;如果中药组合物的原料组成或者技术效果是不容易想到的,则该中药组合物发明具备创造性。在中药组合物发明的创造性与中药药理的关系问题上,具备创造性的发明必然符合中药药理,但符合中药药理的发明不一定具备创造性,而人们对中药药理的认识也是不断拓展和深化的。     

中药“保健增乳乐”对围产期奶牛血液生化指标的影响

试验选用30头干奶牛随机分成试验Ⅰ组、Ⅱ组及对照组(Ⅲ),观察中药“保健增乳乐”对围产期奶牛血液生化指标的影响。在此基础上,异地选择10头干奶牛随机分成试验组(Ⅰ)和对照组(Ⅱ)进行了重复试验。结果显示:中药“保健增乳乐”能显著地降低产后奶牛血清谷草转氨酶(SGOT)、血清γ—谷氨酰转肽酶(Sγ—GT)、血清碱性磷酸酶(SALP)的活性(P<0.05),血清酮体含量(KB)、血清甘油三酯(TG)含量显著减少(P<0.01)。血糖(G)含量升高(P<0.05)。血清钙、无机磷的含量维持正常水平。结果显示中药“保健增乳乐”能有效地改善围产期奶牛的肝脏功能,维持奶牛的正常代谢,预防奶牛围产期的营养代谢性疾病。     

临床共情的基本路径研究

目的：开展临床共情基本路径研究,调查共情基本路径执行现状,为共情临床实践提供建议。方法：利用自行设计的调查问卷,采用分层随机抽样方法,对江苏省8所公立医院825名临床工作者和在这些医疗机构就诊的807例患者的临床共情基本路径现状进行调查和分析,对医务工作者和患者共情的认知状况进行比较。结果：在临床共情基本路径中的神态、情绪、倾听、微笑环节,医务工作者与患者的认知存在偏差;在耐心、专注、语言、告知、解释环节临床工作者均表现不佳。结论：临床工作者各路径环节表现不佳,需结合临床共情路径的内涵和实施方法,促进临床共情实践的实现和发展。     

江苏省综合性医院临床医生对新医改认知研究

为了解江苏省综合性医院临床医生对新医改现状的看法,评价新医改在江苏省内的实施进展和效果,该研究选取了新医改部分重点问题,采用自设计问卷,调查江苏省内7家三级综合性医院和7家二级综合性医院临床医生,运用描述性分析和卡方检验辅助分析研究结果。发现66.5%的医生更希望政府医改经费投入能侧重于医务人员劳动收入;对家庭医生签约服务的认知度及成效评价低于分级诊疗及医联体建设;认为医患关系和看病难、看病贵问题略有改善的医生分别占20.3%、24.9%、27.9%。需正确认识医务人员认知差异及原因;重视医务人员权益、优化薪酬管理制度;加强家庭医生签约服务的宣传和推广;丰富医联体间活动形式;建立及时有效的临床医生反馈机制。     

Treatment Choice With Trial Data: Statistical Decision Theory Should Supplant Hypothesis Testing

Abstract

A central objective of empirical research on treatment response is to inform treatment choice. Unfortunately, researchers commonly use concepts of statistical inference whose foundations are distant from the problem of treatment choice. It has been particularly common to use hypothesis tests to compare treatments. Wald’s development of statistical decision theory provides a coherent frequentist framework for use of sample data on treatment response to make treatment decisions. A body of recent research applies statistical decision theory to characterize uniformly satisfactory treatment choices, in the sense of maximum loss relative to optimal decisions (also known as maximum regret). This article describes the basic ideas and findings, which provide an appealing practical alternative to use of hypothesis tests. For simplicity, the article focuses on medical treatment with evidence from classical randomized clinical trials. The ideas apply generally, encompassing use of observational data and treatment choice in nonmedical contexts.     

Schizotypal Personality Disorder: A Clinical Social Work Perspective

Schizotypal personality disorder (SPD) is considered to be a “schizophrenia spectrum disorder” as evidenced in part by its cross-listing in that chapter of the DSM-5. SPD is considered to be a condition with limited potential for positive change because one of its major features is the presence of a biologically based cognitive deficit. This assumption, however, is an example of the medical model’s creating a bias against psychosocial features that are always involved in character development. The social work profession’s bio-psycho-social perspectives focus more comprehensively on all features of the condition and promote a more optimistic view of clients’ change potentials. The purposes of this paper are to examine SPD from a social work perspective and to demonstrate, with a case example, how effective intervention can be organized and delivered.     

Bayes shrinkage estimator for consistency assessment of treatment effects in multi-regional clinical trials

The primary objective of a multi-regional clinical trial is to investigate the overall efficacy of the drug across regions and evaluate the possibility of applying the overall trial result to some specific region. A challenge arises when there is not enough regional sample size. We focus on the problem of evaluating applicability of a drug to a specific region of interest under the criterion of preserving a certain proportion of the overall treatment effect in the region. We propose a variant of James-Stein shrinkage estimator in the empirical Bayes context for the region-specific treatment effect. The estimator has the features of accommodating the between-region variation and finiteness correction of bias. We also propose a truncated version of the proposed shrinkage estimator to further protect risk in the presence of extreme value of regional treatment effect. Based on the proposed estimator, we provide the consistency assessment criterion and sample size calculation for the region of interest. Simulations are conducted to demonstrate the performance of the proposed estimators in comparison with some existing methods. A hypothetical example is presented to illustrate the application of the proposed method.     

The precision of regression-type estimator for incremental cost–effectiveness ratio

The estimation of incremental cost–effectiveness ratio (ICER) has received increasing attention recently. It is expressed in terms of the ratio of the change in costs of a therapeutic intervention to the change in the effects of the intervention. Despite the intuitive interpretation of ICER as an additional cost per additional benefit unit, it is a challenge to estimate the distribution of a ratio of two stochastically dependent distributions. A vast literature regarding the statistical methods of ICER has developed in the past two decades, but none of these methods provide an unbiased estimator. Here, to obtain the unbiased estimator of the cost–effectiveness ratio (CER), the zero intercept of the bivariate normal regression is assumed. In equal sample sizes, the Iman–Conover algorithm is applied to construct the desired variance–covariance matrix of two random bivariate samples, and the estimation then follows the same approach as CER to obtain the unbiased estimator of ICER. The bootstrapping method with the Iman–Conover algorithm is employed for unequal sample sizes. Simulation experiments are conducted to evaluate the proposed method. The regression-type estimator performs overwhelmingly better than the sample mean estimator in terms of mean squared error in all cases.