• 【身体吸引力对获得酒精的影响: 当社会政策符合社会决策时。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:McCall M
    BACKGROUND & AIMS: Despite numerous legal interventions, minors continue to purchase and consume alcohol. Prior research had suggested that the decision to request identification to prove legal age was susceptible to various judgement and decision heuristics. This research examined whether the physical attractiveness of the potential consumer and the presence or absence of others were significant predictors of alcohol accessibility. Bartenders (n = 130) rated a target individual who was either high or low in attractiveness. Results indicated that attractiveness was a significant predictor of "proofing likelihood". High levels of attractiveness were associated with a decrease in the likelihood of being asked to provide proof of legal age for the purchase of alcohol. Individuals presented alone were seen as significantly older than when grouped with others. Implications of these findings for the restriction of alcohol availability among minors are considered.

    背景与目标: 尽管有许多法律干预,未成年人仍继续购买和消费酒精。先前的研究表明,要求证明合法年龄的决定容易受到各种判断和决策启发式的影响。这项研究检查了潜在消费者的身体吸引力以及其他人的存在与否是否是酒精可及性的重要预测因素。调酒师 (n = 130) 对吸引力高或低的目标个体进行了评分。结果表明,吸引力是 “打样可能性” 的重要预测指标。高吸引力与被要求提供购买酒精的法定年龄证明的可能性降低有关。单独出现的人被认为比与他人分组时要大得多。考虑了这些发现对限制未成年人饮酒的影响。
  • 【关于心脏病预防的决策辅助工具对患者与医生的讨论及其预防计划的影响: 一项随机试验。】 复制标题 收藏 收藏
    DOI:10.1186/1472-6963-6-121 复制DOI
    作者列表:Sheridan SL,Shadle J,Simpson RJ Jr,Pignone MP
    BACKGROUND & AIMS: BACKGROUND:Low utilization of effective coronary heart disease (CHD) prevention strategies may be due to many factors, but chief among them is the lack of patient involvement in prevention decisions. We undertook this study to test the effectiveness of an individually-tailored, computerized decision aid about CHD on patients' discussions with their doctor and their plans for CHD prevention. METHODS:We conducted a pilot randomized trial in a convenience sample of adults with no previous history of cardiovascular disease to test the effectiveness of an individually-tailored, computerized decision aid about CHD prevention against a risk factor list that patients could present to their doctor. RESULTS:We enrolled 75 adults. Mean age was 53. 59% were female, 73% white, and 23% African-American. 66% had some college education. 43% had a 10-year CHD risk of 0-5%, 25% a risk of 6-10%, 24% a risk of 11-20%, and 5% a risk of > 20%. 78% had at least one option to reduce their CHD risk, but only 45% accurately identified the strategies best supported by evidence. 41 patients received the decision aid, 34 received usual care. In unadjusted analysis, the decision aid increased the proportion of patients who discussed CHD risk reduction with their doctor from 24% to 40% (absolute difference 16%; 95% CI -4% to +37%) and increased the proportion who had a specific plan to reduce their risk from 24% to 37% (absolute difference 13%; 95% CI -7% to +34%). In pre-post testing, the decision aid also appeared to increase the proportion of patients with plans to intervene on their CHD risk (absolute increase ranging from 21% to 47% for planned medication use and 5% to 16% for planned behavioral interventions). CONCLUSION:Our study confirms patients' limited knowledge about their CHD risk and effective risk reduction options and provides preliminary evidence that an individually-tailored decision aid about CHD prevention might be expected to increase patients' discussions about CHD prevention with their doctor and their plans for CHD risk reduction. These findings should be replicated in studies with a larger sample size and patients at overall higher risk of CHD.
    背景与目标:
  • 【消费者和政策制定者如何利用系统审查进行决策。】 复制标题 收藏 收藏
    DOI:10.7326/0003-4819-127-1-199707010-00007 复制DOI
    作者列表:Bero LA,Jadad AR
    BACKGROUND & AIMS: Systematic reviews can be a very useful decision-making tool because they objectively summarize large amounts of information, identify gaps in medical research, and identify beneficial or harmful interventions. Consumers can use systematic reviews to help them make health care decisions. Policymakers can use systematic reviews to help them make decisions about what types of health care to provide. Despite the potential value of systematic reviews, little evidence of their direct impact on the decisions made by consumers and policymakers is available. We discuss strategies for optimizing the use of systematic reviews by increasing the awareness and identification of reviews, learning to critically evaluate the findings of reviews, and overcoming barriers to the incorporation of reviews into the decision-making process. In addition, the participation of consumers and policymakers in the design, conduct, and reporting of systematic reviews can help to produce reviews that are relevant and understandable to target audiences. Because decisions that involve health care policies and issues are complex processes in which information (such as that provided by systematic reviews) plays only a part, strategies for increasing the use of systematic reviews should be evaluated for their usefulness in the decision-making process.

    背景与目标: 系统评价可以是一个非常有用的决策工具,因为它们客观地总结了大量信息,确定了医学研究中的差距,并确定了有益或有害的干预措施。消费者可以使用系统的评论来帮助他们做出医疗保健决策。政策制定者可以使用系统的审查来帮助他们决定提供哪些类型的医疗保健。尽管系统审查具有潜在的价值,但几乎没有证据表明它们对消费者和政策制定者做出的决定有直接影响。我们讨论了通过提高对评论的认识和识别,学会批判性地评估评论的结果以及克服将评论纳入决策过程的障碍来优化系统评论使用的策略。此外,消费者和政策制定者参与系统审查的设计,进行和报告可以帮助产生与目标受众相关且易于理解的评论。由于涉及医疗保健政策和问题的决策是复杂的过程,其中信息 (例如由系统审查提供的信息) 仅起一部分作用,因此应评估增加使用系统审查的策略在决策过程中的有用性。
  • 【贝叶斯方法逆向工程蜂窝系统: 非线性高斯网络的仿真研究。】 复制标题 收藏 收藏
    DOI:10.1186/1471-2105-8-S5-S2 复制DOI
    作者列表:Ferrazzi F,Sebastiani P,Ramoni MF,Bellazzi R
    BACKGROUND & AIMS: BACKGROUND:Reverse engineering cellular networks is currently one of the most challenging problems in systems biology. Dynamic Bayesian networks (DBNs) seem to be particularly suitable for inferring relationships between cellular variables from the analysis of time series measurements of mRNA or protein concentrations. As evaluating inference results on a real dataset is controversial, the use of simulated data has been proposed. However, DBN approaches that use continuous variables, thus avoiding the information loss associated with discretization, have not yet been extensively assessed, and most of the proposed approaches have dealt with linear Gaussian models. RESULTS:We propose a generalization of dynamic Gaussian networks to accommodate nonlinear dependencies between variables. As a benchmark dataset to test the new approach, we used data from a mathematical model of cell cycle control in budding yeast that realistically reproduces the complexity of a cellular system. We evaluated the ability of the networks to describe the dynamics of cellular systems and their precision in reconstructing the true underlying causal relationships between variables. We also tested the robustness of the results by analyzing the effect of noise on the data, and the impact of a different sampling time. CONCLUSION:The results confirmed that DBNs with Gaussian models can be effectively exploited for a first level analysis of data from complex cellular systems. The inferred models are parsimonious and have a satisfying goodness of fit. Furthermore, the networks not only offer a phenomenological description of the dynamics of cellular systems, but are also able to suggest hypotheses concerning the causal interactions between variables. The proposed nonlinear generalization of Gaussian models yielded models characterized by a slightly lower goodness of fit than the linear model, but a better ability to recover the true underlying connections between variables.
    背景与目标:
  • 【省卫生服务局的优先事项设定: 关键决策者调查。】 复制标题 收藏 收藏
    DOI:10.1186/1472-6963-7-84 复制DOI
    作者列表:Teng F,Mitton C,Mackenzie J
    BACKGROUND & AIMS: BACKGROUND:In recent years, decision makers in Canada and elsewhere have expressed a desire for more explicit, evidence-based approaches to priority setting. To achieve this aim within health care organizations, knowledge of both the organizational context and stakeholder attitudes towards priority setting are required. The current work adds to a limited yet growing body of international literature describing priority setting practices in health organizations. METHODS:A qualitative study was conducted using in-depth, face-to-face interviews with 25 key decision makers of the Provincial Health Services Authority (PHSA) of British Columbia. Major themes and sub-themes were identified through content analysis. RESULTS:Priorities were described by decision makers as being set in an ad hoc manner, with resources generally allocated along historical lines. Participants identified the Strategic Plan and a strong research base as strengths of the organization. The main areas for improvement were a desire to have a more transparent process for priority setting, a need to develop a culture which supports explicit priority setting, and a focus on fairness in decision making. Barriers to an explicit allocation process included the challenge of providing specialized services for disparate patient groups, and a lack of formal training in priority setting amongst decision makers. CONCLUSION:This study identified factors important to understanding organizational context and informed next steps for explicit priority setting for a provincial health authority. While the PHSA is unique in its organizational structure in Canada, lessons about priority setting should be transferable to other contexts.
    背景与目标:
  • 【通过Dirichlet过程进行贝叶斯单体型推断。】 复制标题 收藏 收藏
    DOI:10.1089/cmb.2006.0102 复制DOI
    作者列表:Xing EP,Jordan MI,Sharan R
    BACKGROUND & AIMS: :The problem of inferring haplotypes from genotypes of single nucleotide polymorphisms (SNPs) is essential for the understanding of genetic variation within and among populations, with important applications to the genetic analysis of disease propensities and other complex traits. The problem can be formulated as a mixture model, where the mixture components correspond to the pool of haplotypes in the population. The size of this pool is unknown; indeed, knowing the size of the pool would correspond to knowing something significant about the genome and its history. Thus methods for fitting the genotype mixture must crucially address the problem of estimating a mixture with an unknown number of mixture components. In this paper we present a Bayesian approach to this problem based on a nonparametric prior known as the Dirichlet process. The model also incorporates a likelihood that captures statistical errors in the haplotype/genotype relationship trading off these errors against the size of the pool of haplotypes. We describe an algorithm based on Markov chain Monte Carlo for posterior inference in our model. The overall result is a flexible Bayesian method, referred to as DP-Haplotyper, that is reminiscent of parsimony methods in its preference for small haplotype pools. We further generalize the model to treat pedigree relationships (e.g., trios) between the population's genotypes. We apply DP-Haplotyper to the analysis of both simulated and real genotype data, and compare to extant methods.
    背景与目标: : 从单核苷酸多态性 (snp) 的基因型推断单倍型的问题对于理解种群内部和种群之间的遗传变异至关重要,对于疾病倾向和其他复杂性状的遗传分析具有重要应用。可以将问题表述为混合模型,其中混合成分对应于种群中的单倍型库。这个池的大小是未知的; 实际上,知道池的大小将对应于了解基因组及其历史的重要信息。因此,用于拟合基因型混合物的方法必须至关重要地解决估计具有未知数量的混合物成分的混合物的问题。在本文中,我们基于称为Dirichlet过程的非参数先验,提出了一种解决此问题的贝叶斯方法。该模型还结合了一种可能性,该可能性捕获了单倍型/基因型关系中的统计误差,将这些误差与单倍型池的大小进行了权衡。我们在模型中描述了一种基于马尔可夫链蒙特卡罗的后验推理算法。总体结果是一种灵活的贝叶斯方法,称为DP-Haplotyper,它使人想起了对小型单体型池的偏爱。我们进一步推广了该模型,以处理人群基因型之间的血统关系 (例如三重奏)。我们将DP-Haplotyper应用于模拟和真实基因型数据的分析,并与现有方法进行比较。
  • 【使用计划行为理论预测非处方药的自我药物治疗。】 复制标题 收藏 收藏
    DOI:10.1177/1359105312465912 复制DOI
    作者列表:Pineles LL,Parente R
    BACKGROUND & AIMS: :Millions of people worldwide use over-the-counter analgesics on a regular basis; yet little is known about how decisions to self-medicate are made. This study used the theory of planned behavior to explore the influence of beliefs about medicines (Beliefs about Medicines Questionnaire) and individual pain experience as predictors of intent to self-medicate. Both emerged as significant predictors of intent to self-medicate. Furthermore, intent to self-medicate significantly predicted reported use of analgesics. These findings indicate that use of over-the-counter pain medication is more likely when the value of the pain relief is greater than concerns about harm.
    背景与目标: : 全世界有数百万人定期使用非处方止痛药; 然而,对于如何做出自我药物的决定知之甚少。这项研究使用计划行为理论来探索对药物的信念 (关于药物的信念问卷) 和个人疼痛体验的影响,以此作为自我治疗意图的预测指标。两者都成为自我治疗意图的重要预测指标。此外,自我药物治疗的意图显著预测了镇痛药的使用。这些发现表明,当缓解疼痛的价值大于对伤害的担忧时,使用非处方止痛药的可能性更大。
  • 8 Solvation models: theory and validation. 复制标题 收藏 收藏

    【溶剂化模型: 理论与验证。】 复制标题 收藏 收藏
    DOI:10.2174/13816128113199990599 复制DOI
    作者列表:Purisima EO,Sulea T
    BACKGROUND & AIMS: :Water plays an active role in many fundamental phenomena in cellular systems such as molecular recognition, folding and conformational equilibria, reaction kinetics and phase partitioning. Hence, our ability to account for the energetics of these processes is highly dependent on the models we use for calculating solvation effects. For example, theoretical prediction of protein-ligand binding modes (i.e., docking) and binding affinities (i.e., scoring) requires an accurate description of the change in hydration that accompanies solute binding. In this review, we discuss the challenges of constructing solvation models that capture these effects, with an emphasis on continuum models and on more recent developments in the field. In our discussion of methods, relatively greater attention will be given to boundary element solutions to the Poisson equation and to nonpolar solvation models, two areas that have become increasingly important but are likely to be less familiar to many readers. The other focus will be upon the trending efforts for evaluating solvation models in order to uncover limitations, biases, and potentially attractive directions for their improvement and applicability. The prospective and retrospective performance of a variety of solvation models in the SAMPL blind challenges will be discussed in detail. After just a few years, these benchmarking exercises have already had a tangible effect in guiding the improvement of solvation models.
    背景与目标: : 水在细胞系统中的许多基本现象中起着积极作用,例如分子识别,折叠和构象平衡,反应动力学和相分配。因此,我们解释这些过程的能量学的能力在很大程度上取决于我们用于计算溶剂化效应的模型。例如,蛋白质-配体结合模式 (即对接) 和结合亲和力 (即评分) 的理论预测需要准确描述伴随溶质结合的水合变化。在这篇综述中,我们讨论了构建捕获这些影响的溶剂化模型的挑战,重点是连续模型和该领域的最新发展。在我们对方法的讨论中,将相对更多地关注泊松方程的边界元解和非极性溶剂化模型,这两个领域已变得越来越重要,但许多读者可能不太熟悉。另一个重点将放在评估溶剂化模型的趋势上,以发现局限性,偏见以及其改进和适用性的潜在吸引力方向。将详细讨论SAMPL盲挑战中各种溶剂化模型的前瞻性和回顾性表现。短短几年后,这些基准测试工作已经在指导溶剂化模型的改进方面产生了切实的效果。
  • 【打破灵长类动物的决策层次结构。】 复制标题 收藏 收藏
    DOI:10.7554/eLife.16650 复制DOI
    作者列表:Hyafil A,Moreno-Bote R
    BACKGROUND & AIMS: :Possible options in a decision often organize as a hierarchy of subdecisions. A recent study concluded that perceptual processes in primates mimic this hierarchical structure and perform subdecisions in parallel. We argue that a flat model that directly selects between final choices accounts more parsimoniously for the reported behavioral and neural data. Critically, a flat model is characterized by decision signals integrating evidence at different hierarchical levels, in agreement with neural recordings showing this integration in localized neural populations. Our results point to the role of experience for building integrated perceptual categories where sensory evidence is merged prior to decision.
    背景与目标: : 决策中的可能选项通常组织为子决策的层次结构。最近的一项研究得出的结论是,灵长类动物的感知过程模仿了这种层次结构,并并行执行子决策。我们认为,直接在最终选择之间进行选择的平面模型对报告的行为和神经数据更为宽容。至关重要的是,扁平模型的特征是决策信号在不同的层次级别上集成了证据,与神经记录一致,表明这种集成在局部神经种群中。我们的结果指出了经验在建立综合感知类别中的作用,在这些类别中,感官证据在做出决定之前就已合并。
  • 【在决策辅助工具中引入阈值是否对患者有益?: 基于发现的诊断决策辅助工具与基于阈值的诊断决策辅助工具之间的比较。】 复制标题 收藏 收藏
    DOI:10.1177/0272989X12461854 复制DOI
    作者列表:Bisig B,Moreira J,Combes M,Asiimwe A,Bisoffi Z,Haegeman F,Bottieau E,Van den Ende J
    BACKGROUND & AIMS: PURPOSE:To assess how different diagnostic decision aids perform in terms of sensitivity, specificity, and harm. METHODS:Four diagnostic decision aids were compared, as applied to a simulated patient population: a findings-based algorithm following a linear or branched pathway, a serial threshold-based strategy, and a parallel threshold-based strategy. Headache in immune-compromised HIV patients in a developing country was used as an example. Diagnoses included cryptococcal meningitis, cerebral toxoplasmosis, tuberculous meningitis, bacterial meningitis, and malaria. Data were derived from literature and expert opinion. Diagnostic strategies' validity was assessed in terms of sensitivity, specificity, and harm related to mortality and morbidity. Sensitivity analyses and Monte Carlo simulation were performed. RESULTS:The parallel threshold-based approach led to a sensitivity of 92% and a specificity of 65%. Sensitivities of the serial threshold-based approach and the branched and linear algorithms were 47%, 47%, and 74%, respectively, and the specificities were 85%, 95%, and 96%. The parallel threshold-based approach resulted in the least harm, with the serial threshold-based approach, the branched algorithm, and the linear algorithm being associated with 1.56-, 1.44-, and 1.17-times higher harm, respectively. Findings were corroborated by sensitivity and Monte Carlo analyses. CONCLUSION:A threshold-based diagnostic approach is designed to find the optimal trade-off that minimizes expected harm, enhancing sensitivity and lowering specificity when appropriate, as in the given example of a symptom pointing to several life-threatening diseases. Findings-based algorithms, in contrast, solely consider clinical observations. A parallel workup, as opposed to a serial workup, additionally allows for all potential diseases to be reviewed, further reducing false negatives. The parallel threshold-based approach might, however, not be as good in other disease settings.
    背景与目标:
  • 【通过健康促进方案支持决策: 移民背景下老龄人的经验。】 复制标题 收藏 收藏
    DOI:10.1080/17482631.2017.1337459 复制DOI
    作者列表:Barenfeld E,Gustafsson S,Wallin L,Dahlin-Ivanoff S
    BACKGROUND & AIMS: :This study is part of the Promoting Aging Migrants' Capabilities programme that applied person-centred group meetings and one individual home visit to prolong independence in daily activities among people ≥70 years who had migrated to Sweden from Finland or the Western Balkan region. With the purpose to understand programme outcomes, the study aimed to explore the participants' everyday experiences of using health-promoting messages exchanged during the programme. Using a grounded theory approach, 12 persons aged 70-83 years were interviewed six months to one year after their participation in the programme. The participants experienced how using health-promoting messages was a dynamic process of how to make decisions on taking action to satisfy health-related needs of oneself or others immediately or deferring action. Five sub-processes were also identified: gaining inner strength, meeting challenges in available resources, being attentive to what is worth knowing, approaching health risks, and identifying opportunities to advocate for others. The results suggest that the programme could develop personal skills to support older people who have migrated to overcome health-related challenges. They further demonstrate the importance of supporting their health literacy before personal resources hinder action, and call for research on programmes to overcome environmental barriers to health.
    背景与目标: : 这项研究是 “促进老龄移民能力” 计划的一部分,该计划采用以人为中心的小组会议和一次个人家访,以延长从芬兰或西巴尔干地区移民到瑞典的70岁以上人群的日常活动独立性。为了了解计划的结果,该研究旨在探索参与者在计划中使用健康促进信息的日常经验。采用扎根理论的方法,对12名年龄在70-83岁的人参加该计划六个月至一年后进行了采访。参与者体验了如何使用促进健康的信息是一个动态的过程,如何决定立即采取行动以满足自己或他人的健康相关需求或推迟采取行动。还确定了五个子过程: 获得内在力量,应对可用资源的挑战,关注值得了解的内容,应对健康风险以及确定为他人辩护的机会。结果表明,该计划可以发展个人技能,以支持为克服健康相关挑战而移民的老年人。他们进一步证明了在个人资源阻碍行动之前支持其健康素养的重要性,并呼吁研究克服环境对健康的障碍的方案。
  • 【贝叶斯网络说明了玉米 (Zea mays L.) 的基因组和残留性状联系。】 复制标题 收藏 收藏
    DOI:10.1534/g3.117.044263 复制DOI
    作者列表:Töpner K,Rosa GJM,Gianola D,Schön CC
    BACKGROUND & AIMS: :Relationships among traits were investigated on the genomic and residual levels using novel methodology. This included inference on these relationships via Bayesian networks and an assessment of the networks with structural equation models. The methodology employed three steps. First, a Bayesian multiple-trait Gaussian model was fitted to the data to decompose phenotypic values into their genomic and residual components. Second, genomic and residual network structures among traits were learned from estimates of these two components. Network learning was performed using six different algorithmic settings for comparison, of which two were score-based and four were constraint-based approaches. Third, structural equation model analyses ranked the networks in terms of goodness of fit and predictive ability, and compared them with the standard multiple-trait fully recursive network. The methodology was applied to experimental data representing the European heterotic maize pools Dent and Flint (Zea mays L.). Inferences on genomic and residual trait connections were depicted separately as directed acyclic graphs. These graphs provide information beyond mere pairwise genetic or residual associations between traits, illustrating for example conditional independencies and hinting at potential causal links among traits. Network analysis suggested some genetic correlations as potentially spurious. Genomic and residual networks were compared between Dent and Flint.
    背景与目标: : 使用新颖的方法在基因组和残留水平上研究了性状之间的关系。这包括通过贝叶斯网络对这些关系的推断以及使用结构方程模型对网络的评估。该方法采用了三个步骤。首先,将贝叶斯多性状高斯模型拟合到数据,以将表型值分解为其基因组和残差成分。其次,从这两个组成部分的估计中学习了性状之间的基因组和残余网络结构。网络学习是使用六种不同的算法设置进行比较的,其中两种是基于分数的,四种是基于约束的方法。第三,结构方程模型分析根据拟合优度和预测能力对网络进行了排名,并将它们与标准的多性状全递归网络进行了比较。该方法应用于代表欧洲杂种玉米库Dent和Flint (Zea mays L.) 的实验数据。关于基因组和残余性状连接的推论被分别描述为有向无环图。这些图提供的信息不仅仅是性状之间的成对遗传或残留关联,例如说明条件独立性并暗示性状之间的潜在因果关系。网络分析表明,某些遗传相关性可能是虚假的。比较了凹痕和火石之间的基因组和残余网络。
  • 【一级护理课程理论与实践持续评估的策略。】 复制标题 收藏 收藏
    DOI:10.1016/0260-6917(90)90056-v 复制DOI
    作者列表:Underwood IM,Reed SE
    BACKGROUND & AIMS: :In May 1988, the English National Board (ENB, Statutory Body for Nursing Education for England) issued draft proposals for development of continuous assessment of theory and practice in basic nursing courses. As an integral part of a new curriculum the staff at Wolverhampton School of Nursing have developed a strategy for continuous assessment of theory and practice which now has formal ENB approval. In order to qualify as a person who can apply to be registered on one or more parts of the register students must have demonstrated their ability to acquire the competencies which are specified in Rule 18(1) of the Nurses, Midwives and Health Visitors Rules Approval Order (UKCC 1983). The strategy demonstrates the development and achievement of competencies of Rule 18(1) as they increase in complexity. We do not claim that the strategy is the only framework which could be developed for implementing continuous assessment, nor do we claim that it is flawless. The strategy is intended as a framework which may contribute in assisting other nurse teachers who are in the present position of developing such schemes of assessment.
    背景与目标: : 1988年5月,英国国家委员会 (ENB,英格兰法定护理教育机构) 发布了提案草案,以发展对基础护理课程的理论和实践进行持续评估。作为新课程的组成部分,伍尔弗汉普顿护理学院的工作人员制定了一项持续评估理论和实践的策略,该策略现已获得ENB的正式批准。为了有资格申请在注册的一个或多个部分注册的人,学生必须证明他们有能力获得《护士、助产士和健康访问者规则批准令》 (UKCC 1983) 第18(1) 条规定的能力。该战略展示了规则18(1) 的能力随着复杂性的增加而发展和实现。我们没有声称该战略是可以为实施持续评估而开发的唯一框架,也没有声称它是完美无缺的。该策略旨在作为一个框架,可以帮助目前处于制定此类评估计划的其他护士教师。
  • 【生存模型的贝叶斯案例影响诊断。】 复制标题 收藏 收藏
    DOI:10.1111/j.1541-0420.2008.01037.x 复制DOI
    作者列表:Cho H,Ibrahim JG,Sinha D,Zhu H
    BACKGROUND & AIMS: :We propose Bayesian case influence diagnostics for complex survival models. We develop case deletion influence diagnostics for both the joint and marginal posterior distributions based on the Kullback-Leibler divergence (K-L divergence). We present a simplified expression for computing the K-L divergence between the posterior with the full data and the posterior based on single case deletion, as well as investigate its relationships to the conditional predictive ordinate. All the computations for the proposed diagnostic measures can be easily done using Markov chain Monte Carlo samples from the full data posterior distribution. We consider the Cox model with a gamma process prior on the cumulative baseline hazard. We also present a theoretical relationship between our case-deletion diagnostics and diagnostics based on Cox's partial likelihood. A simulated data example and two real data examples are given to demonstrate the methodology.
    背景与目标: : 我们提出了复杂生存模型的贝叶斯案例影响诊断。我们基于Kullback-Leibler散度 (k-l散度) 开发了关节和边缘后验分布的病例缺失影响诊断。我们提供了一个简化的表达式,用于基于单个病例删除来计算具有完整数据的后验与后验之间的k-l差异,并研究其与条件预测坐标的关系。使用来自完整数据后验分布的马尔可夫链蒙特卡洛样本,可以轻松完成建议的诊断措施的所有计算。我们考虑在累积基线风险上具有伽马过程的Cox模型。我们还提出了基于Cox部分可能性的病例删除诊断与诊断之间的理论关系。给出了一个模拟数据示例和两个真实数据示例来演示该方法。
  • 【医疗决策过程与家庭: 乳腺癌患者及其丈夫的案例。】 复制标题 收藏 收藏
    DOI:10.1111/j.1467-8519.2008.00650.x 复制DOI
    作者列表:Gilbar R,Gilbar O
    BACKGROUND & AIMS: OBJECTIVES:The objectives of the study were (1) to assess similarities and differences between breast cancer patients and their husbands in terms of doctor-patient/spouse relationships and shared decision making; and (2) to investigate the association between breast cancer patients and husbands in terms of preference of type of doctor, doctor-patient relationship, and shared decision making regarding medical treatment. METHOD:Fifty-seven women with breast cancer, and their husbands, completed questionnaires measuring doctor-patient/spouse relationships (paternalism, autonomy), and decision making regarding medical treatment. RESULTS:Patients believe they have a key role in the medical decision-making process (93%) and that the participation of their husbands, and their agreement with the decision, is important (84% and 89%, respectively). Both breast cancer patients and their husbands prefer a shared decision-making process to paternalistic or autonomy-based approaches. CONCLUSION:In contrast to legal and bioethical approaches, which focus on the patient as the primary decision maker, this study reflects a practical recognition of the role of the breast cancer patient's husband in the decision-making process. It also reflects a relational rather than an individualistic perception of patient autonomy.
    背景与目标:

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