检测HBVDNA的临床意义

用PCR方法检测乙型肝炎患者血清中的HBVDNA ,灵敏度高 ,针对性强 ,对乙型肝炎的预防、诊断和治疗提供了广阔的前景。有很重要的临床意义     

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。     

计算机及网络技术与现代临床医学教育

计算机及网络技术是现代信息技术的核心内容,运用于现代临床医学教育前景广阔.研究表明,计算机多媒体是现代临床教学的重要手段,而网络技术的使用将使教学内容及方式发生根本性变革.     

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。     

Assessment of an e-training tool for college students to improve accuracy and reduce effort associated with reading nutrition labels

Objective: Nutrition labels are often underutilized due to the time and effort required to read them. We investigated the impact of label-reading training on effort, as well as accuracy and motivation. Participants: Eighty college students (21 men and 59 women). Methods: The training consisted of a background tutorial on nutrition followed by three blocks of practice reading labels to decide which of two foods was the relatively better choice. Label-reading effort was assessed using an eye tracker and motivation was assessed using a 6-item scale of healthy food-choice empowerment. Results: Students showed increases in label-reading accuracy, decreases in label-reading effort, and increases in empowerment. Conclusions: The nutrition label e-training tool presented here, whether used alone or as part of other wellness and health programs, may be an effective way to boost students’ label-reading skills and healthy food choices, before they settle into grocery shopping habits.     

START: single‐to‐double arm transition design for phase II clinical trials

Phase II clinical trials designed for evaluating a drug's treatment effect can be either single‐arm or double‐arm. A single‐arm design tests the null hypothesis that the response rate of a new drug is lower than a fixed threshold, whereas a double‐arm scheme takes a more objective comparison of the response rate between the new treatment and the standard of care through randomization. Although the randomized design is the gold standard for efficacy assessment, various situations may arise where a single‐arm pilot study prior to a randomized trial is necessary. To combine the single‐ and double‐arm phases and pool the information together for better decision making, we propose a Single‐To‐double ARm Transition design (START) with switching hypotheses tests, where the first stage compares the new drug's response rate with a minimum required level and imposes a continuation criterion, and the second stage utilizes randomization to determine the treatment's superiority. We develop a software package in R to calibrate the frequentist error rates and perform simulation studies to assess the trial characteristics. Finally, a metastatic pancreatic cancer trial is used for illustrating the decision rules under the proposed START design.     

临床专硕“四证合一”培养模式：形塑·评价·优化

将住院医师规范化培训纳入研究生培养过程，新招收的临床专硕必须同步参加住院医师规范化培训，这种双轨合一的制度安排，形成了临床专硕“四证合一”培养改革的动力和路径。改革后师生获得感有所增强，但也存在学习时间过于紧张、科研能力弱化、专业方向（亚专科）模糊等问题。为确保临床实践能力和临床科研能力的培养并重兼得，应寓科研于临床，对培养方案、科室轮训与科研时间分配等进行结构性调整，积极推进医教协同，不断改进和完善指导方式方法，达致临床专硕培养多重目标的平衡与协同优化。     

检验医学在当今临床医学中的重要位置

检验医学已成为一门新兴的、独立的学科,是临床医学的重要组成部分。检验医学应与临床医学紧密结合,医生在临床医疗和科研工作中应充分重视医学检验的重要作用。     

Integrating phase 2 into phase 3 based on an intermediate endpoint while accounting for a cure proportion—With an application to the design of a clinical trial in acute myeloid leukemia

For a trial with primary endpoint overall survival for a molecule with curative potential, statistical methods that rely on the proportional hazards assumption may underestimate the power and the time to final analysis. We show how a cure proportion model can be used to get the necessary number of events and appropriate timing via simulation. If phase 1 results for the new drug are exceptional and/or the medical need in the target population is high, a phase 3 trial might be initiated after phase 1. Building in a futility interim analysis into such a pivotal trial may mitigate the uncertainty of moving directly to phase 3. However, if cure is possible, overall survival might not be mature enough at the interim to support a futility decision. We propose to base this decision on an intermediate endpoint that is sufficiently associated with survival. Planning for such an interim can be interpreted as making a randomized phase 2 trial a part of the pivotal trial: If stopped at the interim, the trial data would be analyzed, and a decision on a subsequent phase 3 trial would be made. If the trial continues at the interim, then the phase 3 trial is already underway. To select a futility boundary, a mechanistic simulation model that connects the intermediate endpoint and survival is proposed. We illustrate how this approach was used to design a pivotal randomized trial in acute myeloid leukemia and discuss historical data that informed the simulation model and operational challenges when implementing it.     

TITE‐BOIN‐ET: Time‐to‐event Bayesian optimal interval design to accelerate dose‐finding based on both efficacy and toxicity outcomes

One of the primary purposes of an oncology dose‐finding trial is to identify an optimal dose (OD) that is both tolerable and has an indication of therapeutic benefit for subjects in subsequent clinical trials. In addition, it is quite important to accelerate early stage trials to shorten the entire period of drug development. However, it is often challenging to make adaptive decisions of dose escalation and de‐escalation in a timely manner because of the fast accrual rate, the difference of outcome evaluation periods for efficacy and toxicity and the late‐onset outcomes. To solve these issues, we propose the time‐to‐event Bayesian optimal interval design to accelerate dose‐finding based on cumulative and pending data of both efficacy and toxicity. The new design, named “TITE‐BOIN‐ET” design, is nonparametric and a model‐assisted design. Thus, it is robust, much simpler, and easier to implement in actual oncology dose‐finding trials compared with the model‐based approaches. These characteristics are quite useful from a practical point of view. A simulation study shows that the TITE‐BOIN‐ET design has advantages compared with the model‐based approaches in both the percentage of correct OD selection and the average number of patients allocated to the ODs across a variety of realistic settings. In addition, the TITE‐BOIN‐ET design significantly shortens the trial duration compared with the designs without sequential enrollment and therefore has the potential to accelerate early stage dose‐finding trials.