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Exploration in Ways and Rationales of Designing A Desirable Webquest
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作者 覃靓 《海外英语》 2017年第4期225-226,共2页
Web Quest is an advanced tool which could provide the significant scaffolding to support instructors through incorporating learning objects within systematic designs of learning activities. The focus of this article i... Web Quest is an advanced tool which could provide the significant scaffolding to support instructors through incorporating learning objects within systematic designs of learning activities. The focus of this article is to explore how a Webquest is designed reasonably and what rationales are implied in such a design through a case study of Webquest design for a group of ESL/EFL learners in Grade 12. The result indicates that a Webquest which is guided by the principles of constructivist problem solving, social interaction and scaffolding learning can be regarded as a desirable Webquest. 展开更多
关键词 WEBQUEST DESIGN RATIONALE
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EQUALITY, DIGNITY, AND SOCIAL HARMONY: EXPLORING THE RATIONALES AND MODELS FOR RECOGNIZING SAME-SEX RELATIONSHIPS IN LAW 被引量:1
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作者 David Bilchitz 《Frontiers of Law in China-Selected Publications from Chinese Universities》 2016年第3期407-432,共26页
One of the major changes that has taken place over the past twenty to thirty years has been the extension of the legal recognition and protections for same-sex relationships in a wide range of countries. A number of j... One of the major changes that has taken place over the past twenty to thirty years has been the extension of the legal recognition and protections for same-sex relationships in a wide range of countries. A number of jurisdictions, including China, are considering the approach that they will adopt. This article seeks firstly to consider the justifications for the legal recognition of same-sex relationships by the state. Three main, compelling rationales are identified which are rooted in notions of the equality of all persons, the dignity and liberty of individuals to form close personal relationships, and the social benefits of recognizing close, personal relationships of same-sex couples. The second part of this article then turns to consider the maimer in which same-sex relationships should be recognized. Four models are identified: a "Partial Rights" model; a "Civil Partnerships" model; a "Marriage Equality" model, and a "Diversity of Relationships" model. Reasons for and against these particular models will be examined. In the conclusion, it shall be argued that the choice of model that has been adopted can be seen to depend on a number of factors: the manner in which equality is conceived in that society; the understanding of same-sex relationships therein, and the religious and cultural opposition to same-sex relationships in that society. The models are also not states of affairs that are fixed for all time and many countries have progressed from less extensive forms of recognition to wider recognition over time. Ultimately, it shall be argued that the rationales underlying the recognition of close personal relationships in the law support the "Marriage Equality" model or the "Diversity of Relationships" model. This article thus seeks to provide an understanding of the rationales and models for recognizing same-sex relationships that have been adopted around the world: Its focus is thus comparative but may, in this way, be useful to lawmakers and advocates for legal reform in this area in China and other jurisdictions around the world. 展开更多
关键词 same-sex relationships MARRIAGE human rights EQUALITY rationales models China
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Rational Engineering of Secondary Metabolic Pathways in a Heterologous Host to Enable the Biosynthesis of Hibarimicin Derivatives with Enhanced Anti-Melanomic Activity
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作者 Xiangyang Liu Fei-Peng Zhao +9 位作者 Tian Tian Wei-Chen Wang Zaizhou Liu Qiang Zhou Xian-Feng Hou Jing Wang Wenli Guo Shuangjun Lin Yasuhiro Igarashi Gong-Li Tang 《Engineering》 SCIE EI CAS CSCD 2024年第7期113-123,共11页
A 61-kb biosynthetic gene cluster(BGC),which is accountable for the biosynthesis of hibarimicin(HBM)B from Microbispora rosea subsp.hibaria TP-A0121,was heterologously expressed in Streptomyces coelicolor M1154,which ... A 61-kb biosynthetic gene cluster(BGC),which is accountable for the biosynthesis of hibarimicin(HBM)B from Microbispora rosea subsp.hibaria TP-A0121,was heterologously expressed in Streptomyces coelicolor M1154,which generated a trace of the target products but accumulated a large amount of shunt products.Based on rational analysis of the relevant secondary metabolism,directed engineering of the biosynthetic pathways resulted in the high production of HBM B,as well as new HBM derivates with improved antitumor activity.These results not only establish a biosynthetic system to effectively synthesize HBMs-a class of the largest and most complex Type-Ⅱpolyketides,with a unique pseudo-dimeric structure-but also set the stage for further engineering and deep investigation of this complex biosynthetic pathway toward potent anticancer drugs. 展开更多
关键词 Hibarimicin BIOSYNTHESIS Heterologous expression Biosynthetic gene cluster Rational engineering Type-II polyketide
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Gate Tunable Labyrinth Domain Structures in a van der Waals Itinerant Ferromagnet Cr_(7)Te_(8)
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作者 Kui Meng Zeya Li +11 位作者 Yicheng Shen Xiangyu Bi Junhao Rao Yuting Qian Zhansheng Gao Peng Chen Caiyu Qiu Feng Qin Jinxiong Wu Feng Luo Junwei Huang Hongtao Yuan 《Chinese Physics Letters》 SCIE EI CAS CSCD 2024年第9期122-132,共11页
Manipulating magnetic domain structure plays a key role in advanced spintronics devices.Theoretical rationale is that the labyrinthine domain structure,normally appearing in ferromagnetic thin films with strong magnet... Manipulating magnetic domain structure plays a key role in advanced spintronics devices.Theoretical rationale is that the labyrinthine domain structure,normally appearing in ferromagnetic thin films with strong magnetic anisotropy,shows a great potential to increase data storage density for designing magnetic nonvolatile memory and logic devices.However,an electrical control of labyrinthine domain structure remains elusive.Here,we demonstrate the gate-driven evolution of labyrinthine domain structures in an itinerant ferromagnet Cr_(7)Te_(8).By combining electric transport measurements and micromagnetic finite difference simulations,we find that the hysteresis loop of anomalous Hall effect in Cr_(7)Te_(8)samples shows distinct features corresponding to the generation of labyrinthine domain structures.The labyrinthine domain structures are found to be electrically tunable via Li-electrolyte gating,and such gate-driven evolution in Cr_(7)Te_(8)originates from the reduction of the magnetic anisotropic energy with gating,revealed by our micromagnetic simulations.Our results on the gate control of anomalous Hall effect in an itinerant magnetic material provide an opportunity to understand the formation and evolution of labyrinthine domain structures,paving a new route towards electric-field driven spintronics. 展开更多
关键词 RATIONAL ELECTROLYTE FERROMAGNETIC
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Approximate solution of Volterra-Fredholm integral equations using generalized barycentric rational interpolant
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作者 Hadis Azin Fakhrodin Mohammadi 《Applied Mathematics(A Journal of Chinese Universities)》 SCIE CSCD 2024年第2期220-238,共19页
It is well-known that interpolation by rational functions results in a more accurate approximation than the polynomials interpolation.However,classical rational interpolation has some deficiencies such as uncontrollab... It is well-known that interpolation by rational functions results in a more accurate approximation than the polynomials interpolation.However,classical rational interpolation has some deficiencies such as uncontrollable poles and low convergence order.In contrast with the classical rational interpolants,the generalized barycentric rational interpolants which depend linearly on the interpolated values,yield infinite smooth approximation with no poles in real numbers.In this paper,a numerical collocation approach,based on the generalized barycentric rational interpolation and Gaussian quadrature formula,was introduced to approximate the solution of Volterra-Fredholm integral equations.Three types of points in the solution domain are used as interpolation nodes.The obtained numerical results confirm that the barycentric rational interpolants are efficient tools for solving Volterra-Fredholm integral equations.Moreover,integral equations with Runge’s function as an exact solution,no oscillation occurrs in the obtained approximate solutions so that the Runge’s phenomenon is avoided. 展开更多
关键词 Barycentric rational interpolation Volterra-Fredholm integral equations Gaussian quadrature Runge's phenomenon
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Smoking of Carica papaya in Nigeria:The rationale,the public health effects and policies for intervention
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作者 Abolaji Paul Adekeye 《Asian Pacific Journal of Tropical Medicine》 SCIE CAS 2024年第3期95-96,共2页
Psychoactive substance use is characterized by the habitual use of substances that have significant effects in altering the activities of neurotransmitters in certain regions of the brain.Consequently,these alteration... Psychoactive substance use is characterized by the habitual use of substances that have significant effects in altering the activities of neurotransmitters in certain regions of the brain.Consequently,these alterations manifest as cognitive,emotional,perceptual and behavioural changes in affected individuals[1]. 展开更多
关键词 RATIONAL behaviour EMOTIONAL
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Blockchain-Based Key Management Scheme Using Rational Secret Sharing
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作者 Xingfan Zhao Changgen Peng +1 位作者 Weijie Tan Kun Niu 《Computers, Materials & Continua》 SCIE EI 2024年第4期307-328,共22页
Traditional blockchain key management schemes store private keys in the same location,which can easily lead to security issues such as a single point of failure.Therefore,decentralized threshold key management schemes... Traditional blockchain key management schemes store private keys in the same location,which can easily lead to security issues such as a single point of failure.Therefore,decentralized threshold key management schemes have become a research focus for blockchain private key protection.The security of private keys for blockchain user wallet is highly related to user identity authentication and digital asset security.The threshold blockchain private key management schemes based on verifiable secret sharing have made some progress,but these schemes do not consider participants’self-interested behavior,and require trusted nodes to keep private key fragments,resulting in a narrow application scope and low deployment efficiency,which cannot meet the needs of personal wallet private key escrow and recovery in public blockchains.We design a private key management scheme based on rational secret sharing that considers the self-interest of participants in secret sharing protocols,and constrains the behavior of rational participants through reasonable mechanism design,making it more suitable in distributed scenarios such as the public blockchain.The proposed scheme achieves the escrow and recovery of personal wallet private keys without the participation of trusted nodes,and simulate its implementation on smart contracts.Compared to other existing threshold wallet solutions and keymanagement schemes based on password-protected secret sharing(PPSS),the proposed scheme has a wide range of applications,verifiable private key recovery,low communication overhead,higher computational efficiency when users perform one-time multi-key escrow,no need for trusted nodes,and personal rational constraints and anti-collusion attack capabilities. 展开更多
关键词 Blockchain smart contract rational secret sharing key management
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Scientific principles for accelerating the Sustainable Development Goals
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作者 Bojie Fu Xutong Wu +1 位作者 Shuai Wang Wenwu Zhao 《Geography and Sustainability》 CSCD 2024年第2期157-159,共3页
The Sustainable Development Goals(SDGs)are significantly off-course as we reach the midpoint of their 2030 deadline.From a scientific perspective,the critical challenge in achieving the SDGs lies in the need for more ... The Sustainable Development Goals(SDGs)are significantly off-course as we reach the midpoint of their 2030 deadline.From a scientific perspective,the critical challenge in achieving the SDGs lies in the need for more scientific principles to understand the complex socio-ecological systems(SES)and their interactions influencing the 17 SDGs.Here,we propose a scientific framework to clarify the common scientific principles and the rational treatment of diversity under these principles.The framework’s core is revealing the complex mechanisms underlying the achievement of each Sustainable Development Goal(SDG)and SDG interactions.Building upon the identified mechanisms,complex SES models can be established,and the implementation of SDGs can be formulated as a multi-objective optimization problem,seeking a compromise in competition between essential costs and desired benefits.Our framework can assist countries,and even the world in accelerating progress towards the SDGs. 展开更多
关键词 PRINCIPLES SUSTAINABLE RATIONAL
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Experimental study of core MHD behavior and a novel algorithm for rational surface detection based on profile reflectometry in EAST
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作者 叶凯萱 周振 +20 位作者 张涛 马九阳 王嵎民 李恭顺 耿康宁 吴茗甫 文斐 黄佳 张洋 邵林明 杨书琪 钟富彬 高善露 喻琳 周子强 向皓明 韩翔 张寿彪 李国强 高翔 the EAST Team 《Plasma Science and Technology》 SCIE EI CAS CSCD 2024年第3期66-75,共10页
Microwave reflectometry is a powerful diagnostic that can measure the density profile and localized turbulence with high spatial and temporal resolution and will be used in ITER,so understanding the influence of plasm... Microwave reflectometry is a powerful diagnostic that can measure the density profile and localized turbulence with high spatial and temporal resolution and will be used in ITER,so understanding the influence of plasma perturbations on the reflect signal is important.The characteristics of the reflect signal from profile reflectometry,the time-of-flight(TOF)signal associated with the MHD instabilities,are investigated in EAST.Using a 1D full-wave simulation code by the Finite-DifferenceTime-Domain(FDTD)method,it is well validated that the local density flattening could induce the discontinuity of the simulated TOF signal and an obvious change of reflect amplitude.Experimental TOF signals under different types of MHD instabilities(sawtooth,sawtooth precursors and tearing mode)are studied in detail and show agreement with the simulation.Two new improved algorithms for detecting and localizing the radial positions of the low-order rational surface,the cross-correlation and gradient threshold(CGT)method and the 2D convolutional neural network approach(CNN)are presented for the first time.It is concluded that TOF signal analysis from profile reflectometry can provide a straightforward and localized measurement of the plasma perturbation from the edge to the core simultaneously and may be a complement or correction to the q-profile control,which will be beneficial for the advanced tokamak operation. 展开更多
关键词 MHD instabilities profile reflectometry rational surface detection convolutional neural network(CNN) EAST tokamak
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Effect of three-volt moxibustion with helium-neon laser irradiation on quality of care in patients with lumbar radiculopathy spondylosis
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作者 Xiu-Kun Ji Jian Li 《World Journal of Clinical Cases》 SCIE 2024年第15期2522-2528,共7页
BACKGROUND Lumbar radiculopathy spondylosis is a relatively common orthopedic disease with a high incidence rate.It most commonly occurs in the lumbar 4-5 and lumbar 5-sacral 1 vertebrae,which account for approximatel... BACKGROUND Lumbar radiculopathy spondylosis is a relatively common orthopedic disease with a high incidence rate.It most commonly occurs in the lumbar 4-5 and lumbar 5-sacral 1 vertebrae,which account for approximately 95%of cases.It mostly occurs in people aged 30-50 years old and greatly affects their quality of life.AIM To determine the effect of triple-voltage acupuncture combined with helium-neon laser irradiation on the quality of care and improvement of symptoms in patients with lumbar radiculopathy spondylolisthesis.METHODS In this study,we selected 120 patients with lumbar radiculopathy spondylosis who were treated at our hospital between June 2019 to June 2020.The patients were divided into control and observation groups according to the random number table method,with 60 patients in each group.Patients in the observation group were treated with three-volt moxibustion combined with helium-neon laser irradiation,and those in the control group were treated with lumbar traction.After 1 month of treatment,the lumbar pain scores,lumbar spine motor functions,clinical treatment effects,and nursing satisfaction of the two groups were compared.RESULTS The results showed that acupuncture combined with laser irradiation significantly improved the patients'clinical symptoms,i.e.,reduced their low back pain,significantly lower numerical rating scale pain scores in the observation group than in the control group,and better lumbar spine motility than in the control group,compared to lumbar traction.In addition,they were cared for.The treatment effectiveness rate of the observation group was 95.5%,which was significantly higher than that of the control group(81.67%).Satisfaction with care was higher than 90 points in both groups,but the difference was not statistically significant.CONCLUSION Our study provides a clinical rationale for the future treatment of patients with lumbar spine disease.However,further extensive research is needed for validation. 展开更多
关键词 MOXIBUSTION Laser irradiation Clinical rationale Lumbar spine Three-volt moxibustion
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Practice of Perioperative Rational Use of Antibacterial Drugs Based on Drug Pathway
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作者 Changkai ZHOU Fanbo JING +1 位作者 Haijun QU Jing GAO 《Medicinal Plant》 2024年第2期57-60,64,共5页
[Objectives]To establish a new management model for rational use of perioperative antibacterial drugs in surgical departments.[Methods]Based on evidence-based medicine,the department s drug pathway was formulated,and ... [Objectives]To establish a new management model for rational use of perioperative antibacterial drugs in surgical departments.[Methods]Based on evidence-based medicine,the department s drug pathway was formulated,and the new mode of rational drug use control was established by using fine pharmaceutical technology intervention,and the intervention effect was evaluated by the intensity of antibacterial drug use,per capita drug costs and the proportion of drugs.[Results]After adopting drug pathway in departments,the intensity of antibacterial drug use,per capita drug costs and the proportion of drugs decreased significantly,and the effect of rational drug use control was remarkable.[Conclusions]The drug pathway provides a new management and control mode for the rational use of perioperative antibacterial drugs in surgical departments of hospitals.Thus,it is worthy of popularization and application. 展开更多
关键词 Perioperative period Antibacterial drugs Drug pathway Rational drug use Management model
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Rationale and Pathway for New Industrialization in the Context of Chinese Modernization
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作者 Huang Qunhui Li Fangfang 《China Economist》 2024年第4期2-14,共13页
The concepts of modernization and industrialization have different connotations that are specific to their historical backgrounds,and their theoretical innovation and development may benefit from China’s experiences.... The concepts of modernization and industrialization have different connotations that are specific to their historical backgrounds,and their theoretical innovation and development may benefit from China’s experiences.Industrialization is the cornerstone of modernization,and holds the key to its success.China’s experiences in blazing a new trail of industrialization are challenging the traditional Western theory of industrialization and deepening the connotations of Chinese modernization.New industrialization is a key entry point for steering China’s modernization drive and theoretical innovations.This paper offers an overview of the theory of Chinese modernization and its evolving trend along China’s socialist industrialization path,as well as the rationale and pathway for new industrialization in the context of Chinese modernization.As our findings suggest,the new industrialization concept has taken hold in every key aspect of Chinese modernization.When combined with the theory of Chinese modernization,the theoretical implications of new industrialization play a crucial role in propelling Chinese modernization forward along a new journey in the new era. 展开更多
关键词 New industrialization Chinese modernization coordinated evolution theoretical rationale practical pathway
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Exact controllability of rational expectations model with multiplicative noise and input delay
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作者 Wenjing Wang Juanjuan Xu +1 位作者 Huanshui Zhang Minyue Fu 《Journal of Automation and Intelligence》 2024年第1期19-25,共7页
This paper considers the rational expectations model with multiplicative noise and input delay,where the system dynamics rely on the conditional expectations of future states.The main contribution is to obtain a suffi... This paper considers the rational expectations model with multiplicative noise and input delay,where the system dynamics rely on the conditional expectations of future states.The main contribution is to obtain a sufficient condition for the exact controllability of the rational expectations model.In particular,we derive a sufficient Gramian matrix condition and a rank condition for the delay-free case.The key is the solvability of the backward stochastic difference equations with input delay which is derived from the forward and backward stochastic system. 展开更多
关键词 Rational expectations model Exact controllability Exactly null controllability Multiplicative noise Input delay
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Research on Improving Energy Consumption Management Strategies
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作者 Ma Jie 《China Oil & Gas》 CAS 2024年第4期50-56,共7页
The deduction of energy consumption for raw materials and non-fossil energy in the calculation of energy intensity involves a simple change that will have direct and profound impacts.This paper reviews the historical ... The deduction of energy consumption for raw materials and non-fossil energy in the calculation of energy intensity involves a simple change that will have direct and profound impacts.This paper reviews the historical context and current status of China’s energy intensity control strategies,dissects the rationale for recent adjustments in energy intensity calculation methodologies,and examines policy changes from the perspectives of actively responding to internal and external challenges to promote energy transition,coordinating development and emissions reduction based on China’s energy resource endowment,and transforming energy intensity control as a driving force for accelerating the development of strategic emerging industries and high-quality growth. 展开更多
关键词 driving POLICY RATIONAL
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The Global Security Initiative: Its Relevance, Rationale and Delivery
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作者 Liu Shiqiang 《Contemporary World》 2024年第2期34-38,共5页
Today,our world is undergoing profound changes unseen in a century.Global security landscape is becoming ever more unstable and uncertain.In the face of growing deficits in security,Chinese President Xi Jinping put fo... Today,our world is undergoing profound changes unseen in a century.Global security landscape is becoming ever more unstable and uncertain.In the face of growing deficits in security,Chinese President Xi Jinping put forward the Global Security Initiative(GSI),offering a clear answer to the question of the times:what kind of security concept does the world need,and how can we achieve common security?It is of great significance to fully grasp the relevance of and the rationale for the GSI,and push for its strategic delivery,so as to contribute to the long-term peace and stability of the world. 展开更多
关键词 RATIONAL offering RATIONAL
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Green Olympics
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《ChinAfrica》 2024年第10期58-59,共2页
The Double Take column looks at a single topic from an African and Chinese perspective.This month we discuss to what extent the idea of Green Olympics is rational.The organisers of the Paris Olympics took some unusual... The Double Take column looks at a single topic from an African and Chinese perspective.This month we discuss to what extent the idea of Green Olympics is rational.The organisers of the Paris Olympics took some unusual measures such as absence of air conditioning in a quite hot weather and lack of meat in food for athletes in their bid to hold the“greenest-ever”Olympic games this August.This has sparked a discussion on how we should balance a low-carbon lifestyle with other human needs such as comfort and nutrition. 展开更多
关键词 RATIONAL WEATHER UNUSUAL
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Whole Perfect Vectors and Fermat’s Last Theorem
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作者 Ramon Carbó-Dorca 《Journal of Applied Mathematics and Physics》 2024年第1期34-42,共9页
A naïve discussion of Fermat’s last theorem conundrum is described. The present theorem’s proof is grounded on the well-known properties of sums of powers of the sine and cosine functions, the Minkowski norm de... A naïve discussion of Fermat’s last theorem conundrum is described. The present theorem’s proof is grounded on the well-known properties of sums of powers of the sine and cosine functions, the Minkowski norm definition, and some vector-specific structures. 展开更多
关键词 Fermat’s Last Theorem Whole Perfect Vectors Sine and Cosine Functions Natural and Rational Vectors Fermat Vectors
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Evaluation of the Effectiveness of Community Pharmacy Services on Rational Medication Use in Elderly Patients with Hypertension and Diabetes
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作者 Tian Zheng Xulin Huang Lei Liu 《Journal of Clinical and Nursing Research》 2024年第3期12-17,共6页
Objective:To explore the effect of community pharmacy services on rational medication use in elderly patients with hypertension and diabetes.Methods:Between November 2022 and December 2023,80 elderly patients with hyp... Objective:To explore the effect of community pharmacy services on rational medication use in elderly patients with hypertension and diabetes.Methods:Between November 2022 and December 2023,80 elderly patients with hypertension and diabetes were selected and randomly divided into a control group(routine medication guidance)and an observation group(community pharmacy services),with 40 subjects each.The medication effect scores,blood pressure,blood sugar levels,and quality of life scores before and after intervention were compared between the two groups.Results:Comparison of pharmaceutical knowledge,medication compliance,and safe medication behavior scores showed that the observation group had higher scores as compared to the control group(P<0.05);blood pressure(systolic blood pressure,diastolic blood pressure,heart rate)and blood sugar(fasting blood glucose,2 h postprandial blood glucose,glycated hemoglobin)index levels were compared,and the observation group’s index levels were lower than those of the control group(P<0.05);the scores of physical health,mental health,social relationships,and environment in the observation group were higher than those in the control group(P<0.05).Conclusion:Community pharmacy services improved the rational medication effect of elderly patients with hypertension and diabetes,and improved their blood pressure,blood sugar control levels,and quality of life. 展开更多
关键词 Community pharmacy services Elderly hypertension complicated with diabetes Rational medication use
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基于SCA的小型化核心框架研究 被引量:7
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作者 赵秋明 林志堂 +1 位作者 杨莹莹 林敏 《计算机测量与控制》 CSCD 北大核心 2010年第5期1145-1147,共3页
针对软件无线电核心框架(CF)的软件实现相对复杂与具体应用困难等问题,在遵循软件通信架构(SCA)的基础上,通过rational rose建模软件,并采用统一建模语言(UML)对CF进行建模分析,对核心框架的部分接口进行裁剪,提出一种适合于工程应用的... 针对软件无线电核心框架(CF)的软件实现相对复杂与具体应用困难等问题,在遵循软件通信架构(SCA)的基础上,通过rational rose建模软件,并采用统一建模语言(UML)对CF进行建模分析,对核心框架的部分接口进行裁剪,提出一种适合于工程应用的小型化核心框架(mini-CF),同时研究分析mini-CF的在软件无线电中的具体实现;通过与SCA核心框架的比较,得出该mini-CF可减少软件实现的复杂度,减小占用软件无线电硬件平台的资源,使软件无线电系统更易于实现与应用。 展开更多
关键词 软件通信架构 RATIONAL ROSE mini—CF 软件无线电
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国家组织药品集中采购和使用试点对临床用药管理与使用的影响 被引量:27
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作者 何江江 唐密 +7 位作者 丛鹂萱 徐源 宋捷 陈珉惺 杨燕 张晓溪 冯旅帆 金春林 《中国卫生资源》 北大核心 2021年第1期29-31,共3页
目的调查国家组织药品集中采购和使用试点(以下简称“‘4+7’试点”)的影响,提出政策建议,为进一步推行国家组织药品集中采购提供参考。方法用焦点组访谈法,对北京、上海、广州、西安和沈阳5个试点城市的64位医疗保险管理者、卫生行政... 目的调查国家组织药品集中采购和使用试点(以下简称“‘4+7’试点”)的影响,提出政策建议,为进一步推行国家组织药品集中采购提供参考。方法用焦点组访谈法,对北京、上海、广州、西安和沈阳5个试点城市的64位医疗保险管理者、卫生行政管理者、医院管理者和医师代表进行访谈。用问卷调查法,就政策影响对5个试点城市的509位医师和498位患者进行分层抽样调查。结果医师对“4+7”试点的认可程度高,认为药品的临床效果达标,不良反应处于常态水平。患者给予中标药品正向反馈,对中标药品的接受度较高,试点降低了患者的医疗费用,患者满意度较高。试点也存在医院为达成政策实施目标而限制医师的处方权、医师工作量加大但激励不足等问题。结论药品集中采购的积极影响明显,但要实现控制药品总费用、保障药品供应和“三医联动”的目标,还应平行推进相关配套改革措施,如加快医疗保险支付改革,依托药品临床综合评价以真实世界数据推动药品的遴选和合理使用,调整医药费用结构,促进公立医院绩效及薪酬制度改革,推进行业监管和医疗卫生服务精细化管理等。 展开更多
关键词 医疗卫生机构medical institution 药品drug 集中采购centralized procurement 带量采购procurement with quantity 政策影响policy impact 药事管理pharmacy administration 合理用药rational drug use
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