The landscape of innovation in bacteria,battleships, and beyond

We draw lessons from microbial experimental evolution and naval warfare to improve the understanding of innovation in financial markets. Major financial innovations often arise without explicit societal planning because novel approaches can be favored by markets, in a manner strikingly parallel to natural selection. We utilize the concept of an adaptive landscape to characterize environments that increase the speed and magnitude of innovation. We apply this adaptive landscape framework to innovation in portfolio management. We create a general taxonomy for understanding and nurturing innovation.     

综合性医院日间化疗病房医护一体化管理模式探索与实践

目的：探讨综合性医院日间化疗病房管理模式的改革与创新,解决肿瘤患者住院难、治疗不及时、患者流失等方面的问题。方法：确定日间化疗收治对象、收治流程;建立日间化疗管理新模式;对新模式的运作进行不断的优化、改进和创新,实现日间化疗病房医护一体化管理新模式。结果：日间病房在医护人员配置和空间设置上可节约成本约50%以上。从2010年至2013年,日间病房患者由治疗轮次1轮增加到2-2.5轮,每月治疗人次由300人次增加到900多人次,日间化疗病房床位使用率由100.50%上升到245.00%;2013年患者住院满意度达99.95%,比2010年上升3.93%;获得患者表扬信由47封上升到299封。连续2年无投诉。结论：综合性医院设立日间化疗病房在方便肿瘤化疗患者治疗的同时,明显缓解了肿瘤患者等候住院时间,提高了病房的床位使用率,降低了医疗成本,提高了患者及家属的满意度。     

护理专业硕士研究生创新能力现状及影响因素分析

目的调查护理专业硕士研究生创新能力现状及影响因素,为研究生创新能力培养提供依据。方法选取14所大学在读护理专业硕士研究生164名,采用自制护理专业研究生创新现状与影响因素调查问卷对其进行调查并分析。结果护理专业硕士研究生创新能力总分为(11.59±1.17)分,学习行为、学习目的、学位选择方式、与同学、家人及导师沟通、研究工作评价对其具有影响作用(P0.01或P0.05)。结论护理专业硕士研究生的创新能力一般,可以通过帮助调剂研究生调整心态、改变学习态度、鼓励多查阅文献了解国际动态等方式提高研究生的创新能力。     

From the Cover: Increasing disparities between resource inputs and outcomes,as measured by certain health deliverables,in biomedical research

Society makes substantial investments in biomedical research, searching for ways to better human health. The product of this research is principally information published in scientific journals. Continued investment in science relies on society’s confidence in the accuracy, honesty, and utility of research results. A recent focus on productivity has dominated the competitive evaluation of scientists, creating incentives to maximize publication numbers, citation counts, and publications in high-impact journals. Some studies have also suggested a decreasing quality in the published literature. The efficiency of society’s investments in biomedical research, in terms of improved health outcomes, has not been studied. We show that biomedical research outcomes over the last five decades, as estimated by both life expectancy and New Molecular Entities approved by the Food and Drug Administration, have remained relatively constant despite rising resource inputs and scientific knowledge. Research investments by the National Institutes of Health over this time correlate with publication and author numbers but not with the numerical development of novel therapeutics. We consider several possibilities for the growing input-outcome disparity including the prior elimination of easier research questions, increasing specialization, overreliance on reductionism, a disproportionate emphasis on scientific outputs, and other negative pressures on the scientific enterprise. Monitoring the efficiency of research investments in producing positive societal outcomes may be a useful mechanism for weighing the efficacy of reforms to the scientific enterprise. Understanding the causes of the increasing input-outcome disparity in biomedical research may improve society’s confidence in science and provide support for growing future research investments.Few forces have transformed society more than science. Knowledge gained through the scientific method has lifted billions out of poverty, fueled industrialization and mass communication, eradicated smallpox, and placed human footprints on the moon. During the 20th century, science was increasingly funded by governments and corporations vying for military and economic advantage. Furthermore, the realization that investments in biomedical research translated into medical advances garnered strong societal support for the expenditure of public funds to support science. Today, science is a vast industry producing new knowledge, usually to address particular problems or questions facing humankind. Like any industry, the scientific enterprise uses tools and resources—scientists, money, and time—to produce an output: scientific knowledge, which can be represented by publications in the scientific literature.To remain competitive, corporations have long sought to maximize production efficiency, defined here as the ratio of output to input, by trimming waste and producing more (1). With increasing competition for research grants and jobs, funders and employers have turned to measures of efficiency and productivity to evaluate scientists (2). Such pressures have created well-documented incentives for scientists to maximize apparent productivity through publication numbers, citation counts, and publishing in high-impact journals (3, 4). Although this approach is designed to reward those who contribute most to the knowledge base, recent studies have raised questions about the quality of the biomedical literature (5–8). One such study found that only 11% of findings could be confirmed in 53 “landmark” hematology and oncology publications (6). Another study found that 43 of 67 published cardiovascular, oncological, and women’s health findings could not be reproduced (7). Recently, it was estimated that more than $28 billion is spent each year in the United States on irreproducible preclinical research and that the prevalence of these studies in the literature exceeds 50% (8). We note that this lack of reproducibility was identified by the National Institutes of Health (NIH) as a major problem and has led to initiatives for enhancing reproducibility and transparency (9). The irreproducibility of published data could potentially waste limited funding, years of work, and threatens to undermine public confidence in the scientific enterprise.A pure focus on scientific outputs can ignore the quality of those outputs. This is partially due to the fact that the quality and importance of scientific publications, unlike most human products, is subjective and difficult to assess in the present (10, 11). The true measure of a study’s quality would involve time-consuming and costly independent replication and an analysis of the work’s outcomes, including assessing its downstream utility to other applications and its effects on society. However, given the length of time needed and low probability of any given study generating substantial societal impact, it is very difficult to judge individual scientists or their work using simple outcome measures. Valid scientific research can have tremendous intrinsic societal value in producing information without the need for tangible outcomes. However, we also assume that all valid scientific research has some probability of generating tangible outcomes, even though such outcomes can be unpredictable and distant in both time and subject matter. For example, the theory of general relativity proposed in 1916 did not produce a useful outcome to the public until the late 20th century, when it provided a means to account for differences in clock rates under different gravitational influences, thereby enabling the global positioning systems found in a majority of modern cell phones and vehicles (12). Despite the intrinsic social value of biomedical knowledge, it is evident that public agencies, such as the NIH, support biomedical research with outcome-oriented goals, including benefitting health, preventing disease, and increasing return on investment (13). Although it is impractical to measure the outcomes generated by individual researchers, we believe that it is possible to estimate the outcomes of the biomedical research enterprise. In contrast to the production-based definition of efficiency (outputs ÷ inputs), we believe that evaluating research outcomes relative to inputs can be used to monitor the efficiency of biomedical innovation and the impact of research investments. Without studying outcomes, there is no way of knowing if society’s investment in research is paying off, and there is no way of evaluating the efficacy of systemic modifications to the scientific enterprise.     

以创新为理念的临床应用解剖学教学改革

为了适应21世纪解剖教学改革的趋势,培养研究生的动手能力、创新意识和创新能力,北京协和医学院研究生院临床应用解剖学课程从2010年开始改革,经过5年的教学实践,对所获得的经验及存在的问题进行总结,以期为未来的课程发展提供借鉴.     

The Imaging 3.0 Informatics Scorecard

Imaging 3.0 is a radiology community initiative to empower radiologists to create and demonstrate value for their patients, referring physicians, and health systems. In image-guided health care, radiologists contribute to the entire health care process, well before and after the actual examination, and out to the point at which they guide clinical decisions and affect patient outcome. Because imaging is so pervasive, radiologists who adopt Imaging 3.0 concepts in their practice can help their health care systems provide consistently high-quality care at reduced cost. By doing this, radiologists become more valuable in the new health care setting. The authors describe how informatics is critical to embracing Imaging 3.0 and present a scorecard that can be used to gauge a radiology group’s informatics resources and capabilities.     

辽宁省医药生产企业专利申请现状分析及建议

目的 改善辽宁省制药企业专利申请现状。方法 采集辽宁省制药企业专利的申请量、有效量和申请人类型等数据并统计分析找出创新和专利申请中存在的问题,对提高辽宁省医药企业专利保护水平提出建议。结果 与结论辽宁省制药行业整体创新水平落后,专利保护能力较弱,需加大扶持力度,促进其发展。     

我国创业板制药企业药物研发现状与成果分析

目的分析我国创业板制药企业的药物研发现状与成果。方法选择创业板制药企业中年度营业收入达10亿元的20家企业,从研发投入、专利产出、1类新药产出和仿制药一致性评价现状4个角度分析其药物研发现状与成果。结果在纳入分析的20家企业中,40%研发投入金额不足1亿元,45%研发强度不到5%;19家企业获得了专利授权,但仅8家企业有专利获得了不少于3个国家的授权;仅半数企业有1类新药产出,大多处于临床研究阶段,过去10年内仅有1个1类新药获批上市;7家企业共计21个仿制药处于一致性评价审评中,仅1个产品通过了一致性评价;26项获得不少于3个国家授权的专利和23个在研或上市的1类新药中,分别有15项(57.69%)和9个(39.13%)来自贝达药业。结论我国创业板制药企业大多创新投入少,近半数企业研发强度较低,具有高潜在市场价值的专利储备较少,技术含量高的1类新药较缺乏,一致性评价成果也不足,总体研发实力较弱。虽整体创新实力不足,但也有个别企业创新成果丰硕。