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.     

耳鼻咽喉头颈外科的临床教学思考

综合全面的教学有利于高素质医学专业人才的培养。对于耳鼻咽喉头颈外科专业的本科生及研究生,要提高教学效率,使学生建立三维立体解剖概念,并注重学生显微操作技能和外科基本功的培养,同时重视内窥镜解剖教学。通过此教学经验,可以充分提高学生的实际操作能力。     

医学临床实习存在问题及对策研究

医学临床实习是高等医学教育的重要组成部分,临床实习的成败,直接关系到医学生的培养质量和医学院校的可持续发展。就当前临床实习中存在的一些问题进行分析研究,认为加强管理,提高师生双方对实习重要性的认识,将有利于提高临床医学教学质量的提高。     

案例式PBL教学法在消化内科临床实习中的应用

在消化内科临床实习教学中,采用问题式学习（problem-based learning,PBL）和案例式教学相结合形成的案例式PBL教学法,能够充分发挥学生的主观能动性,有效提高学生主动学习和分析、解决问题的能力,并促进其临床思维的形成,从而提高了教学质量。运用案例式PBL教学需要关注教师自身的培训和学生参与积极性等方面的问题。     

高职院校顶岗实习研究现状及展望

通过回顾中国学术期刊网络出版总库收录的顶岗实习的文献,文章对顶岗实习的内涵及意义、顶岗实习的模式、顶岗实习存在的问题及其对策和顶岗实习如何管理四个方面的研究进行了系统述评,在此基础上分析了现有研究的不足,并展望了未来的研究方向,最后在综合现有研究成果基础上,得出了“政企校生”四方联动的顶岗实习研究新视角和校企组成利益共同体的职业教育发展方向两点启示。     

导师制在留学生临床实习带教中的应用

导师制在留学生临床实习中起着重要作用。南京医科大学以附属南京第一医院为试点,首次将导师制引入了来华医学留学生临床实习中,初步建立了留学生临床实习导师制的新模式,并按照管理学上PDCA循环（plan-do-check-assessment）的原理进行实施。本文通过分析实施导师制过程中培养模式的确定、组织实施、监督检查及考核评估这4个PDCA循环过程的控制,探讨了南京医科大学＂留学生实习导师制＂所取得的成绩及存在的问题,并提出了相应的改善措施。     

Young adult carers: a literature review informing the re-conceptualisation of young adult caregiving in Australia

The experiences of young adult carers (YACs) have been vastly under-researched, particularly within Australian caregiving literature. This article explores the existence, extent and nature of informal young adult caregiving in Australia, defining YACs as individuals aged between 18 and 25 years who provide unpaid care or support to family members living with chronic illness or disability. The aim of this article is to provide a foundation for the re-conceptualisation of YACs as a distinct carer cohort who, without suitable recognition and specifically targeted support, may experience significantly reduced future life opportunities. The traditional, narrative-based review will first redefine YACs in accordance with overseas literary definitions and will then explore the complex nature and extent of young adult caregiving in Australia. Explanations as to why young adults are increasingly undertaking these informal caregiving roles and how YACs differentiate from their non-carer peers will then follow. Finally, three prominent paradigms, namely the clinical, social capital and carers' rights' perspectives, will be presented to establish a greater understanding of the implications, contextual experiences and unmet civil rights of YACs in Australia.     

Methods for exploring treatment effect heterogeneity in subgroup analysis: an application to global clinical trials

Multi‐country randomised clinical trials (MRCTs) are common in the medical literature, and their interpretation has been the subject of extensive recent discussion. In many MRCTs, an evaluation of treatment effect homogeneity across countries or regions is conducted. Subgroup analysis principles require a significant test of interaction in order to claim heterogeneity of treatment effect across subgroups, such as countries in an MRCT. As clinical trials are typically underpowered for tests of interaction, overly optimistic expectations of treatment effect homogeneity can lead researchers, regulators and other stakeholders to over‐interpret apparent differences between subgroups even when heterogeneity tests are insignificant. In this paper, we consider some exploratory analysis tools to address this issue. We present three measures derived using the theory of order statistics, which can be used to understand the magnitude and the nature of the variation in treatment effects that can arise merely as an artefact of chance. These measures are not intended to replace a formal test of interaction but instead provide non‐inferential visual aids, which allow comparison of the observed and expected differences between regions or other subgroups and are a useful supplement to a formal test of interaction. We discuss how our methodology differs from recently published methods addressing the same issue. A case study of our approach is presented using data from the Study of Platelet Inhibition and Patient Outcomes (PLATO), which was a large cardiovascular MRCT that has been the subject of controversy in the literature. An R package is available that implements the proposed methods. Copyright © 2014 John Wiley & Sons, Ltd.     

EEFSEC基因、染色体17q24和染色体11q13.2基因变异与前列腺癌的关联研究

目的探索EEFSEC基因(rs10934853,A)、染色体17q24区(rs1859962,T)和染色体11q13.2(rs7931342,T)的基因变异类型与前列腺癌患病发病风险的关联,分析这些基因型与前列腺癌患者临床特征的关系。方法采用病例对照研究设计,比较病例组中124例患者和对照组中138例正常对照者的EEFSEC基因(rs10934853,A)、染色体17q24区(rs1859962,T)和染色体11q13.2(rs7931342,T)等位基因和基因型频率的差异,并探讨各基因变异与患者的确诊年龄,BMI,Gleason评分,PSA浓度,肿瘤分期等临床特征之间的关联。结果 EEFSEC基因(rs10934853,A)、染色体17q24区(rs1859962,T)和染色体11q13.2(rs7931342,T)的基因型和等位基因在病例组和对照组中的频率分布差异均无统计学意义(P0.05),然而,EEFSEC基因(rs10934853,A)和染色体17q24区(rs1859962,T)存在更强的基因-基因协同的交互作用(P=0.0396,OR=1.722,95%CI=1.0244~2.8944);病例组基因型-表型观察指标关联分析表明,3个SNPs与PCa患者的年龄、Gleason评分、PSA浓度及烟酒均无关联(P0.05),然而,染色体17q24区(rs1859962,T)位点与食用蛋类有关(P=0.005)。结论 EEFSEC基因(rs10934853,A),17q24(rs1859962,T)和11q13.2(rs7931342,T)位点可能与我国北方人群前列腺癌的发病风险无关联,但是存在有基因之间增加PCa发病风险的协同效应。     

大学生实习期间的权益保护

大学生在实习期间合法权益被侵犯的事件时有发生,其主要原因在于大学生、高等学校和实习单位之间的法律关系主体地位不明确与权利义务关系模糊、实习大学生处于弱势地位以及缺乏法律的特殊关怀。因此,维护大学生在实习期间的合法权益,应当从明确大学生实习所牵涉的法律关系主体入手,建立大学生实习管理制度,完善实习协议约束机制,明确各主体之间的法律地位和权利义务,同时还要通过为实习大学生购买实习意外险的形式建立实习风险分担机制。