非隶属附属医院内涵建设刍议

结合非隶属附属医院的建设实践,从教育观念、教学意识、师资培训、教学管理和教学条件的改善等方面阐述了做好非隶属附属医院内涵建设的重要性和意义。     

Testing for ordered failure rates under general progressive censoring

For exponentially distributed failure times under general progressive censoring schemes, testing procedures for ordered failure rates are proposed using the likelihood ratio principle. Constrained maximum likelihood estimators of the failure rates are found. The asymptotic distributions of the test statistics are shown to be mixtures of chi-square distributions. When testing the equality of the failure rates, a simulation study shows that the proposed test with restricted alternative has improved power over the usual chi-square statistic with an unrestricted alternative. The proposed methods are illustrated using data of survival times of patients with squamous carcinoma of the oropharynx.     

Dynamic allocation as a balancing act

The CPMP Points to Consider on Adjustment for Baseline Covariates recently came into operation. As well as providing sound guidance, this document states a strong position against dynamic allocation. This paper reviews the most important issues involved and aims to stimulate interest in further investigating alternative allocation methods in clinical trials. Copyright © 2004 John Wiley & Sons, Ltd.     

A Bayesian method of sample size determination with practical applications

Summary.  The problem motivating the paper is the determination of sample size in clinical trials under normal likelihoods and at the substantive testing stage of a financial audit where normality is not an appropriate assumption. A combination of analytical and simulation-based techniques within the Bayesian framework is proposed. The framework accommodates two different prior distributions: one is the general purpose fitting prior distribution that is used in Bayesian analysis and the other is the expert subjective prior distribution, the sampling prior which is believed to generate the parameter values which in turn generate the data. We obtain many theoretical results and one key result is that typical non-informative prior distributions lead to very small sample sizes. In contrast, a very informative prior distribution may either lead to a very small or a very large sample size depending on the location of the centre of the prior distribution and the hypothesized value of the parameter. The methods that are developed are quite general and can be applied to other sample size determination problems. Some numerical illustrations which bring out many other aspects of the optimum sample size are given.     

When is a curve an outlier? An account of a tricky problem

ABSTRACT The analysis of a set of data consisting of N short (≤20 observations each) multivariate time series, where the observations are irregularly spaced and where observations for the different components of each multivariate series are observed at different times, is discussed. With the increased use of automatic recording devices in many fields, data such as these, which are of course samples from smooth response curves, are becoming more common. In this application, which was a clinical trial comparing two cements for use in hip replacement surgery, the key to the analysis was in recognizing that the interest lay in the degree to which the five curves representing a patient's vital signs deviated from baseline (i.e., normal for that patient) during surgery. This enabled the statisticians to define appropriate response variables. The analysis included Rosseeuw's (1984) technique for the identification of multivariate outliers and logistic regressions to identify any effects on the process producing the outliers due to treatment or covariates.     

The Invisible (Inaudible) Woman: Nursing in the English Academy

Nursing is numerically a far larger academic discipline than medicine, and is situated in many more higher education institutions in England (over 50), whereas there are 21 medical schools. Like the rest of ‘non medical education and training’ it is purchased through a quasi‐market. Despite the size of this market, however, nursing education has until recently been largely invisible in policy documents and the ambitions of nursing academics to develop their subject are seen as inappropriate. This article explores this invisibility and inaudibility, with particular reference to the 1997 Richards Report, Clinical Academic Careers and the 2001 Nuffield Trust report, A New Framework for NHS/University Relations. It draws on the work of Davies on the ‘professional predicament’ of nursing, to argue that, although the move of nursing education into higher education had the aim of improving its status, nursing has difficulty finding its voice within academia. As a result, issues which are salient for nursing (as for many of the health professions), such as a poor (or relatively poor) showing in the Research Assessment Exercise and the complexities of balancing research, teaching and maintaining clinical competence, are raised as high‐profile issues only in medicine.     

论高职高专诊所式法律教育教学模式的构建

诊所式法律教育是20世纪60年代兴起的一种比较新型的法学教学模式。在高职高专法学专业引进诊所式法律教育,建立适合高职高专学生的教学模式是十分必要的。在高职高专构建诊所式法律教学模式,应有自己独特的教学对象、教学形式和课程体系。案例教学法、讨论式教学法、角色模拟教学法、单独指导教学法等理应成为高职高专诊所式法律教学的主要方法。     

Placing Clinical Social Workers “Between a Legal Rock and a Practice Hard Place”: Reactions to Madden and Parody

The debate about the veracity of incest memories uncovered in therapy is often impassioned and acrimonious. Recent statements by various professional organizations, advising that corroboration of recovered memories is the only method for determining their accuracy, have not decreased the intensity of this debate. This response to Madden and Parody's paper discusses the importance of corroboration of recovered memories of sexual abuse and details the clinical, scientific, and legal foundations for this approach. A point of confusion in Madden and Parody's paper and an important aspect of this response is the difference between clients who uncover completely new memories of childhood sexual abuse and clients who enter therapy with a history of sexual abuse. Those clients with new memories are the focus of this debate and the standard of care proposed in this paper.     

NEAREST NEIGHBOUR ANALYSIS OF UNEQUALLY REPLICATED TRIALS

There has been much work on the use of neighbouring plots to control environmental variation in the analysis of agricultural field experiments. In particular, the Residual Maximum Likelihood Neighbour (REMLN) analysis of Gleeson&Cullis (1987) appears very promising. The application of the REMLN analysis to an unequally replicated field trial augmented with an additional variety planted every six plots in a grid system is here compared with a covariance (COV) analysis using the neighbouring grid or check plot values as the covariate. The results indicate that the REMLN analysis gives more accurate estimates of treatment contrasts than the COV analyses, but that the estimate of treatment means can be biased. The bias depends on the mean of the check plot. This bias can be removed by adjusting the estimates of the treatment means such that their average equals the average of the raw means rather than that of the raw data.     

A constructivist approach to the help-seeking process of clients: A response to cultural diversity

The issue of cultural diversity presents clinicians with both delemmas and opportunities. To deal with such a challenge, I have proposed a constructivist approach to the help-seeking process of clients from diverse ethnoracial backgrounds. A model of clients' help-seeking processes provides a useful and systematic frame for clinicians to understand clients' construction of their problem situations and possible solutions. It provides a useful key for clinicians non-presumptuously to understand clients' subjective experiences, and to enhance clients' ability to resolve problems.