The Devil is in the Detail: Clinicians,Academics and Researchers Resolving the Problems of Clinical Research

The difficulties associated with conducting valid family therapy research within a clinical practice discourage many potential researchers. This article will describe collaboration between a group of academics, researchers and clinicians who decided to explore the process and efficacy of systemic family therapy conducted within a working private practice. The specific questions we are addressing are, whether the requests clients bring to their first session of therapy can be reliably classified by practitioners, whether these requests change over time, and whether the nature of the request is associated with therapist and client ratings of therapeutic outcome. Additional questions about the form and nature of the therapeutic alliance as experienced by both client and practitioner are also being explored. This paper will map the passage of the work from inception to its current state where over 140 clients are active participants. In doing so attention will be paid to the obstacles encountered: practical, financial and ethical, and the solutions devised to address these.     

并购绩效的经验研究方法

结合典型的并购经验研究的方法和结果,比较了并购绩效经验研究中经常使用的长期绩效研究法、事件研究法、诊断研究法和调查法等4种方法各自的含义与特点,同时考察了国外及国内并购经验研究对4种方法的运用情况,提出了在我国目前条件下适宜的研究方法的建议。     

An Asymptotic Analysis of the Logrank Test

Asymptotic expansions for the null distribution of the logrank statistic and its distribution under local proportional hazards alternatives are developed in the case of iid observations. The results, which are derived from the work of Gu (1992) and Taniguchi (1992), are easy to interpret, and provide some theoretical justification for many behavioral characteristics of the logrank test that have been previously observed in simulation studies. We focus primarily upon (i) the inadequacy of the usual normal approximation under treatment group imbalance; and, (ii) the effects of treatment group imbalance on power and sample size calculations. A simple transformation of the logrank statistic is also derived based on results in Konishi (1991) and is found to substantially improve the standard normal approximation to its distribution under the null hypothesis of no survival difference when there is treatment group imbalance. This revised version was published online in July 2006 with corrections to the Cover Date.     

诊所法律教育:我国法学实验教学的新领域

诊所法律教育是许多国家和地区所广泛采用的法律实践性教育模式.诊所法律教育在教学活动主体、教学内容等方面具有鲜明的特色.诊所法律教育在2000年被正式引入我国法律教育体系,并逐渐成为我国法学实验教学的重要领域之一.     

盐酸多奈哌齐治疗血管性痴呆的临床疗效观察

目的观察盐酸多奈哌齐治疗血管性痴呆的疗效。方法102例血管性痴呆患者随机分为2组，治疗组51例，在常规治疗的基础上给予盐酸多奈哌齐5mg，每日1次；对照组54例，给予常规治疗，两组患者疗程均为12周，观察治疗前后认知功能（MMSE、HDS）及日常生活自理能力（ADL）的改善程度。结果治疗12周时，治疗组MMSE、HDS及ADL评分明显改善，较对照组有显著性差异（P〈0．05），自身对照结果显示，盐酸多奈哌齐治疗12周，治疗后MMSE、HDS及ADL评分较治疗前改善（P〈0．01），在治疗4周时，MMSE、HDS及ADL评分已有提高。结论盐酸多奈哌齐治疗血管性痴呆疗效确切，对患者认知功能及日常生活能力均为改善，无明显副作用，值得临床推广。     

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。     

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.     

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.     

"处方教学"及其应注意的几个问题

教学方法改革是当前教育改革的重要内容。恰当运用“处方教学”的方法,解决学生在学习中存在的具体问题,成为临床教学改革的一个可供参考的模式。     

医学生临床阶段素质教育几点措施

素质教育已成为当前我国高等医学教育的重要内容,提高医学生素质刻不容缓。医学生临床教育阶段是素质教育的关键阶段,要围绕素质教育,在思想政治教育、医学课程、教学方式方法、教学条件、教师队伍建设等方面深入进行改革,端正临床教育方向。